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w' <br /> NON-HAZARDOUS RDOUS 1. Generator's US PAA ID No. Manifest Doc.No. 2. Page 1 <br /> WASTE MANIFEST ' . Z�O Z�-,/ of <br /> 3. SQn9[ators Name and,Fling Address <br /> 4. n s <br /> 5. ransporter 1 CompWy Name 6. US EPA)D Number A. Transppoortte�r's Phone r� <br /> 7. Transporter 2 Company Name 8. US EPA ID Number B. Transportees Phone <br /> 9. D signatteed Facility Nameand Site Address 10. US EPA ID Number C. Facility's Phone <br /> i $. vL <br /> 11.Waste Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> 42 No. I Type Quantity Wt/Vol <br /> M ba a sA Y <br /> E <br /> T <br /> v <br /> R <br /> d. a •'fts�'"�` t �• y �.'wc ^rte .A.:&�:w .ax.:."� "Y'' .�, sy.v a ,.d <br /> amt, <br /> .¢"3 KW9,' rsnr." f r3 { <br /> E. Handling Codes for Wastes Listed Above <br /> v ' <br /> .15.Special Handling Instructions and Additional Information a <br /> Al iA (1A <br /> 16.GENE dN: ce the materials described above on this manifest are not subject to federal regulations for-reporting proper disposal of Hazardous Waste. <br /> 'opyped N Signature Month- Day Year <br /> Z nit W, ®�.... <br /> T 17.Transporter 1 A owledgement of Receipt of Materials <br /> R <br /> A /P''9t_ed/Typad e , Sign re Month Day Year <br /> N l_�•t f S"M r a <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> E Printed/Typed Name Signature Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> 20.Facility Owner or Operator.Certification of receipt of waste materials covered by this manifest except as noted <br /> T <br /> Y Print Na e - Signatu Year <br /> ,zn <br /> ir <br /> -� ORIGINAL—RETURN TO GENERATOR �, �>s �,.�� . <br />