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W <br />Q <br />N <br />M <br />O <br />0 <br />cc <br />Q <br />N <br />Q <br />1 <br />Z <br />Z <br />NON -HAZARDOUS WASTE°MANIFEST <br />Please print or luno (Farm desianod for use on elite (12 p(tchJ typewriteO <br />CF14 0 2002 LA6ELMASTER® (600) 621 <br />NON -HAZARDOUS <br />1, Generalor's US EPA ID No. <br />Manifest <br />2. <br />Page 1 <br />DacumentNo. `'s,saa_}a <br />: <br />WASTE MANIFEST <br />of <br />3, Generator s ryartin and Moiling Address <br />r <br />L <br />4, Generators Phone I ''N64 <br />Trransporfpr�l 6. <br />anyName^ <br />US EPA ID purr bar. <br />yt <br />A. State Transponor's ID <br />=5. JComp <br />ff <br />§ t E?'v £:g ay' i` £ i <br />r, <br />'g `-7 <br />tJ} JJ <br />S. Transporter 1 Phone =': <br />> <br />7, Transporter 2 Company Name 6, <br />US EPA ID Number <br />C. State Transponees ID <br />D. Transporter 2 Phone <br />Dessgneted Facility, and Site Address 10. <br />US EPA ID Number <br />E. Stats Facility's ID <br />(9. <br />df N_z'.4: R, <br />F. Facility's Phone <br />11, WASTE DESCRIPTION <br />Containers <br />13. <br />144 <br />Total <br />Unit <br />No, <br />Type <br />Ouantity <br />Wt Me] <br />a a•s : f'sr=.? _',�'siv:`=.,N t., � �. `; �' 'Si.;._?fit <br />, <br />G <br />b. <br />E <br />N <br />E <br />R <br />C. <br />A <br />T <br />O <br />R <br />d. <br />G, Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed <br />Above <br />44. <br />: <br />,yam <br />15. Special Handling Instructions and Additional Information <br />WAWA <br />16. GENERATOR'S CERTIFICATION: i hereby certify that the contents of this shipment <br />aro fully and accurately described and are <br />in ail respects <br />In proper Wndition for transport. PIG motorists described on this manifest are not subject to federal hazardous waste <br />ragulalions. <br />Date <br />Prinlad(Typed Name <br />Signature pf <br />; <br />Month <br />Day <br />j <br />41 <br />i7Year <br />T <br />17' Transporter 1 Acknowledgement at Receipt of Materials <br />Date <br />Red[ <br />A <br />�,.,...... f <br />ETypad Name <br />gnslurs. <br />; -., <br />Month <br />Da <br />Year.. <br />N <br />tf <br />;. <br />1 <br />S <br />- r <br />p <br />16. Transporter 2 Acknowledgement of Receipt of Materials <br />Date <br />R <br />T <br />Printedlryped Name <br />Signature <br />Month <br />Day <br />Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />Ci <br />L-20. <br />2D. Facility Owner or Operator: Certification of receipt of the waste mateliafs covered by this manifest, except as noted in <br />item 19, <br />f <br />bate <br />TT <br />Printed/Typed Namo <br />Signature <br />Month <br />Day <br />Year <br />Y <br />-5808 wwl�.labelmaster.com <br />�OVINK <br />