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mer US EPA ID No. <br />Manifest <br />2. Page 1 <br />7I <br />Document No. <br />ILL LADING_ <br />BOF <br />.87..ik <br />3, Generator's Name and Mailing Address <br />4. Generator's Phone <br />5. Transporter 1 Company Name S. US EPA ID Number <br />A. State Transporter's ID <br />B. Transporter I Phone <br />% <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />C, State Transporter's ID <br />D. Transporter 2 Phone <br />9. Designated Facility Name and Site Address 10. US EPA If) Number <br />E. State Facility's ID <br />F. Facility's Phone <br />11. WASTE DESCRIPTION <br />12. Containers <br />13. <br />14. <br />Tote! <br />Unit <br />No. <br />Type <br />Quantity <br />WI.Nol <br />a. <br />b, <br />C. <br />d. <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed Above <br />15. Special Handling losinjolions and Additional Information <br />0 N'. <br />At. <br />16, GENERATOR'S CERTIFICATION: I hereby certify that the contents of this shipment are fully and accurately described and are in <br />all respects <br />In proper condition for transport. The materials described on this manifest are not subject to federal hazardous waste regulations. <br />Dale <br />Printcd[Typcd Name <br />Signature <br />morilh <br />Day year <br />T <br />17. Transporter I Acknowledgement of Receipt of Materials <br />Date <br />IR <br />A <br />Printed/Typed Name <br />Signature <br />Month <br />Day Year <br />N <br />P <br />0 <br />18. Transporter 2 Acknowledgement of Recelp . I of Matereis <br />Dale <br />R <br />T <br />— <br />Prinlecirryped Name <br />Signature <br />mon1rh <br />Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />20. Facility Owner or Operator; Certification of receipt of the waste materials covered by this manifest, except as noted In item 19. <br />Date <br />T <br />Prinleffrryped Name <br />Signature <br />Month <br />Day Year <br />Y <br />