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S <br /> NONHAZARDOUS 1.Generator ID Number 2 Page 1 of 3.Emergency Response Phone. 4,W9SW Tracking Number <br /> WASTE MANIFEST I - <br /> 5.Generator shame and Ma7ing Adores 'Gene s Sits Address(4 ddterant than,�pa.!R_N-COL--4) <br /> 4 � �kwop r C°�) 14(q- sof' <br /> enrol ea Phone: <br /> B,Transporter 1 Company Nam <br /> r U.S.EPA ID Number <br /> 7.r porter 2 Company Name 1 r'! <br /> U.S.EPA ID Number <br /> U.Designated Faaaty Noma and Site Address CO/es JC'�rFII�S Ty` <br /> rU.S.EPA 1D Nuoriber <br /> ,6o3-x�- �z-� 16 �o Er, <br /> aaT: s Phone: ot'f vJ }f�'�C� Ltf q 3�U'� !=rLee' / <br /> 9.waste Skipping Name and Desaiptron 10.Containers 11.Total 12,Unit <br /> 1' L- ,%f ver,5,, No. Type Quantity WLNof. <br /> f�'so�S JOM 5--Zel <br /> 2. <br /> 3, <br /> 1 <br /> 4 <br /> fI <br /> 13.Spedal Handling InstructJons and Ad Monall�prmabon <br /> f la 014C)II) is,'- as= csx <br /> 14GENERATOR'SIOFFERogrS CEFMFICAT10Nr l hereby dedare that ft contends of this oonsignmant are fully and acarratey described <br /> marked and Iebeledfplararded,end are In 29 respects in proper eanditia_n far stents Of eccarding to At ar bfe fully <br /> and tonal end national by�pier stripping name,and are classified,-a Mr <br /> �G6­a'ne—r&eWWeWsPdnt8dTyped Name govemmental WW=. <br /> Signature Month Day Year <br /> -J 15.International Shipments <br /> ❑import to U.S. ❑Export frm}.0 , ort of enbwexih. <br /> TAr`-%vier S ,attire rtor a,mcrs r 11 Date leave U.S.: <br /> x 16.Transporter Apclaxledgmer>t of Receipt of Materials <br /> 9 Transporter 1 d Name S. <br /> a L� C Month Day Year <br /> Transporter 2 Printedliyped Name so <br /> I 4; L <br /> (� Month Day Year <br /> 17 Oscrepancy <br /> 17a.Discrepancy Indication Space ❑Ouarwy ❑Type ❑Residua <br /> ❑Partial Rry:;,x, El Full Rejectbn <br /> 17b,Altemate FaaTity{or Generaor) Manifest Reference Number <br /> U.S EPA ID Number <br /> wFavi 9 Phone. <br /> i 7c.Signature of Aliomate Fatuity41 (ar Generator) <br /> x <br /> Month Day Year <br /> -;D- <br /> 18 De' algid Faaa - 'i• <br /> sgrr ty Owner or Operator.Certification of receipt of materi�s covered by rine manifest except as rated In Item 17a _ <br /> Prlrrtedliyped Name <br /> I Month Day Year <br /> S1 9-IBLG0 6 10498(Rev.9109) <br /> TRANSPORTER#1 <br />