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W <br />U) <br />N <br />4 <br />Z <br />2 <br />NON=HAZARDOUS WASTE MANIFEST <br />Please print or type (Forrn designed for use on a {12 pitch) typewriter} <br />CF14 ©2002 LaBELMASTER0 (800) <br />NDN-HAZARQtiUS <br />1. Genomtor's US EPA ID No, <br />Manifest <br />2. <br />Page t <br />``:` a <br />Document No. 3" .,r_'-','- <br />y <br />WASTE MANIFEST <br />of <br />ttrator s jT. and Mailing Address <br />3. Ge�}Si <br />r •i F .:.:i� <br />Ct,Fer2S <br />ttt <br />4. Genorator's Phone ( ") <br />apspoqer�t CampARy:(�a �w <br />r+�;) 6. <br />US EPA lP Nu� <br />A. State 7ransportar s ID <br />s£4`rvY3 y i <br />B. Transporter 1 Phone <br />7. Transporter 2 Company Name 8. <br />US EPA ID Number <br />C. State Transpodor's ID <br />D. Transporter 2 Phone <br />Designated Facility Name and Site AddreT3S_gs, t 0. <br />U5 EPA i0 Number <br />E. State Facility's ID <br />'?€.1 <br />�a<9 <br />i`e.i 42e+Wii_v�2A x�?�.�F-3:Sk�:=.�'ri �: ��r.t4 f:,<'isY <br />{ <br />,'�1a1. <br />t,dX 5 R x, <br />rr,4, rr- <br />R Facilitys Phone <br />pp <br />11- WASTE DESCRIPTION <br />Containers <br />19, <br />14, <br />Total <br />Unit <br />No. <br />Type <br />Quantity <br />Wt.Nol. <br />G <br />b. <br />E <br />N <br />E <br />R <br />a. <br />A <br />T <br />0 <br />R <br />� <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes tasted Above <br />. £ 3 07e, <br />AT <br />15. Spacial Handling Instructions and Additional Information <br />1 <br />W [[W � a v W W <br />F^ tK- <br />M mss*+.. _ <br />W <br />.. <br />16. GENERATOR'S CERTIFICATION: I hereby certify that the contents of this shipment <br />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 />Pr rated rypad Nart?e <br />Signature ;' J 'j • <br />Month <br />Day r Yam <br />.' <br />T <br />17. Transporter t Acknowledgement of Receipt of Materials <br />Date <br />APuntedriyped1ilanno <br />£lgnal(rra <br />Month <br />Day Year <br />t <br />i.°' ' '( i=it <br />f <br />pit ¢� � <br />f l 3" rHf i :�}`j <br />p <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />Date <br />R <br />T <br />Printed(f}•pe¢I Name <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 Operator. Certillcation of receipt of the waste materials covered by <br />this manifest, except as noted in item 19. <br />( <br />Data <br />T <br />TF77pod <br />NameSignature <br />Month <br />Day Year <br />Y <br />621.5808 www.labalmaster.com <br />®v, ctiOStln 1!e'GYnCi rs'�rt+3 Cay INK Oyii- <br />vav: corxE._v.x SrN <br />