Laserfiche WebLink
LLI <br />a <br />0 <br />0 <br />cc <br />Q <br />N <br />Z <br />Z <br />NON -HAZARDOUS WASTE MANIFEST <br />Please print or type lrofm designed for use on ofcte (t2 pitchj typotwiter, <br />CF14 ©2002 LABELMASTEfi0 (800) 621.5808 www, label master, cam <br />NON -HAZARDOUS <br />1. Goneralors US GPA Ip No. <br />Manifest <br />2. <br />Pago t <br />F'.u-:(i.rr°<F ,:,.: <br />Document No, <br />>%r;_:1. <br />WASTE MANIFEST <br />of <br />..� <br />P1,£3e`lterrrato F;. w,)q,and Mailing Address <br />4. Ganorators Phone <br />Y5-.7mnspart rpt ��otitp� y,Na ,; - 6. <br />�°s�l&< 'i 'tc; <br />US EPA ID Numbi <br />i P k�-.t <br />A. State Transportets ID <br />r <br />; F1114910,13 <br />r t <br />B. Transporter t Phone <br />y <br />,z: <br />7. Transporter 2 Company Name 8. <br />US EPA ID Number <br />C. State Transportar's ID <br />D. Transporter 2 Phone <br />'.9. Des gated FaciJily, lame and Site Addross 70. <br />US EPA ID Number <br />E, State Pacllity's ID t <br />x,R�; <br />• t. i`+I <br />a..s,l'•£€tfa'. <br />_, <br />+� <br />d: <br />F. Facility's Phone <br />11, WASTE DESCRIPTION <br />Containers <br />13. <br />14, <br />Total <br />Unit <br />No, <br />Typo <br />Quantity <br />WtNoi. <br />: <br />/r <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 />Abovo <br />15. Special Handling Instructions and Additional information <br />16. GENERATOR'S CERTIFICATION; I hereby certify that ilia contents of fttis shipment <br />are full yy and accurately described <br />and are <br />in all respects <br />in proper condition for transport. Tha materials described on this manifest are not subject to laderal hazardous waste <br />regulations. a <br />Date <br />Printedljyped Name .. <br />Signature <br />MPE?th <br />Day Year <br />r <br />f <br />i <br />t` <br />T <br />17, Transporter 1 Acknowiedgemant of Receipt of Materials <br />Date <br />A <br />1 <br />PfintedlTypddName p <br />Slgnature <br />ccMonth <br />Day Year <br />N <br />" <br />S <br />F <br />p <br />18. Transporter 2 Acknowledgement of Recotpt of Materials <br />Date <br />R <br />T <br />Printed/Typed Norm <br />Signature <br />Month <br />Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />20, Facility Owner or Oporntor. Certification of receipt of ilia waste materials covered by this manifest, except as noted <br />In item 19. <br />Date <br />T <br />PrintedtTypod Name <br />Signature <br />Month <br />Day Year <br />Y <br />[[�in_q srns[u, ra _��y1NKj <br />