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NON-HAZARDOUS 1. Generators I No. ManifestPage <br /> WASTE MANIFEST erator" n of <br /> 3. s N ma Mailing Address ��I l - � <br /> Ro <br /> 4. Generator's Phone( ) <br /> 5. Transporter 1 Company Name -6. - US EPAJD14umber A. Transporter's Phone - <br /> r� S b 0 ar- <br /> 7. Transporter 2 Company Name 8. US EPA ID Number B. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number C. Facilitys Phone <br /> SCD &amj4-o/L <br /> it.I 8 W,514` S�• <br /> cc, <br /> 11.Waste Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity WI/Vol <br /> a D N A'?,An fit c.►C�i tC i . <br /> r <br /> ic._ -tit, • o.o-ir D r-56 <br /> G b. <br /> E <br /> R <br /> Ac. <br /> T _ <br /> O <br /> R <br /> d. <br /> D A for rials ,~ £.-Handling Codes for Wastes `it;. , <br /> 15.Special Handling Instructions and Additional Information <br /> hJ�A� '�1�PfE2�' =G►�t,r�.� �oTt{rfJ6dJN�E.ts h���-er.JfD <br /> to(oZ- <br /> 16.GENERATOR'S CERTIFICATION: ' ft materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> P t N Si ature Month Day Year <br /> T 17.Transporter 1 Acknowledgemen of Receipt of Ma e <br /> R <br /> AN • ed/T ame Signat Month rpy <br /> S / <br /> P <br /> O 18.Transporter 2 Acknowledgement of Re Ipt of Materials <br /> R Prints Monte Day <br /> G <br /> 19.D�prepancy Ind# do : ` S t ®a_0'\1 R R <br /> F <br /> A <br /> C <br /> I <br /> 20.Facility Owner or Operator.Certification of re p waste materials covered by this manifest except as noted in Item 1 . <br /> T <br /> Y Print � �/ Signature <br /> ORIGINAL—RETURN TO GENERATOR <br />