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W <br />Q <br />N <br />0 <br />a <br />z <br />Q <br />N <br />4 <br />z <br />Z <br />0 <br />Z <br />: <br />NON -HAZARDOUS WASTE MANIFEST <br />Please print or tvae (Form dest(lned for use on etito (12 pitch) typewriter) <br />CF14 02002 LAUELNiASTERm (800) <br />NON -HAZARDOUS 1 Gonerator'sUSEPA IDNo. <br />Manifest <br />2.Page 1 <br />`F'`s'' :5 `' <br />Document Na. <br />WASTE MANIFEST <br />of <br />p <br />3. Gengrplor's Name and Mailing Address <br />old <br />d. Generator's Phone <br />5. Transpit or t Company Name 6. <br />12 <br />US EPA <br />IDNuobeerr. y3, ttL <br />A. State T(ansportors ID <br />ri?)Fi-'Sr..#.1:5[}..r1 <br />a4';it#'rP.Lfi1 r`� A..y��Cliv#'ri3„1:+.r <br />Iszk <br />B. Trans <br />EGA <br />7 Transported 2 Company Name U. <br />US EPA <br />ID Number <br />C. State Transporter's ID <br />D. Transporter 2 Phone <br />9. Designated Facilit}y Name and Site Address 10, <br />7l <br />US EPA <br />ID Number <br />E. State Facility's ID <br />1 l f RIO I <br />VI'MN) <br />t �ir4'tf3=#i a) �.aiv vd <br />• dAl . <br />44#R#v F ii1; <br />y « <br />F Facility's Phone <br />11. WASTE DESCRIPTION <br />Containers <br />7d3af <br />U14. <br />nit <br />No. Type <br />Quantity <br />%NMoi. <br />G <br />b. <br />E <br />N <br />E <br />:R <br />:.. <br />A <br />T <br />O <br />R <br />t. <br />G. Additional Descriptions for Materials Listad Above <br />H. Handling Codes for Wastes Listed <br />Above <br />04 <br />i>'ri i5kj.`, �Siiii��i'•''v tin+lye'+? <br />if rig <br />x <br />15. Special Handling Instructions and Additional Information <br />,-MCA <br />16. GENERATOR'S CERTIFICATION: I hatchconily that Ilio contents of this shipment <br />are fully and <br />accurately described and are in all respects <br />in proper condition for transport. The matorrils described on this manifest are riot subject <br />to federal <br />hazardous wasfo <br />regulations. <br />Date <br />Pr.. cdayped Name <br />Signature <br />l f <br />_ <br />hfnnfh <br />pay Year <br />/{ <br />T <br />17 Transporter 1 Acknawfedgeniant of Receipt of Materials <br />Date <br />R <br />A <br />Prioted7ypddName <br />Signature <br />A4onUr <br />play Year <br />N <br />> <br />P <br />Q <br />I6. Transporter 2 Acknoistedgemont of Receipt of Materials <br />Dato <br />Ft <br />T' <br />Priniadrfypod Name <br />Signature <br />Month <br />Day Year <br />E <br />R <br />19. Discrepancy Indialian Space <br />F <br />A <br />C <br />LCo. <br />Facility Qi+ner or Operator Ceniflcation of receipt of ilio waste materials covered by <br />this manifast, except as noted <br />in item 19 <br />Dato <br />e <br />tf!! <br />Signature <br />Month <br />Day Year <br />621=5808 WWW.Iab01fr18518LCOITt <br />®..�.,r�y��rrsn; <br />