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W <br />Q <br />V) <br />Q <br />Q <br />N <br />Q <br />Z <br />Z <br />NON -HAZARDOUS WASTE MANIFEST <br />Flown nrint nr tvnn (Form dasioned for use on elito f 12 Pitch( typewriter) <br />CFid Ev' 2002 LA9ELi`lA5fFR8 (ttoa) s21 -seas www.labolmaster,com <br />SI <br />NK <br />=rrooH.¢ncmr�ucr, f <br />®� w•7n srra:,.�.e.a <br />NON -HAZARDOUS t. Generator's US EPA ID No. <br />Manifest <br />° <br />2. <br />Page 1 <br />a g <br />Document Na... <br />a <br />WASTE MANIFEST a#; <br />.r 3. Generator's Name and Mailing Address <br />Y <br />y`Er k <br />4. Generator's Phone <br />5, Trans ortar 1 Company Name 6. <br />P <br />US EPA ID.Nu b r .... <br />'K <br />$k. <br />A, State Transportar's 10 <br />tgF Y t'r. ,,tt g, iZ=�A <br />$sF s.t &r., as .., t , ref, .i=: <br />$ ;�r.? .Ti-}"`_: <br />t "ge. <br />t'P47117T <br />.; <br />R, Transporter I Phone fit <br />7. Transporter 2 Company Name 3. <br />US EPA ID Number <br />C. State Transpaders ID <br />D. Transporter 2 Phone <br />9. Desionaled Facility Nam@,and Site Address 10, <br />US EPA ID Number <br />E. State Facilities ID <br />f,r<"5e3i't3rnYr,^`? e3i:''{ J'A. <br />Fro Phone ..s ,.• <br />M. <br />¢ I <br />11. WASTE DESCRIPTION <br />I <br />Containers <br />13, <br />14. <br />Total <br />Unit <br />No. <br />Type <br />Quantity <br />WLI <br />r?a�.?iii.; I X'";; �#. �:?:� ?:�t� t S t`.,: C`g �2 t^F4 r f °.e! �"'y?'S' {rtt,.. i,Y<PitLrt� <br />i _. <br />y <br />•-�, <br />it <br />. <br />R <br />° <br />A <br />T <br />0 <br />R <br />d. <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed AboveS"3k3�.+£;t <br />my z: 3:e�iiv3 r 300G,5 <br />15, Special Handling Instructions and Additional Information <br />09 • <br />Y•'' t <br />I <br />AMA <br />2. --.'....� AKA <d <br />d"lr�i.AygF <br />- u�MJa. ..PSI,—.'� <br />Al <br />rf.mu <br />16. GENERATOR'S CERTIFICATION: I hereby certify that the contents of this shipment aro fulland accurately described and are <br />Yaderai <br />in all respects <br />in proper condition for transport. The matar€als described an this manifest are not subject 10 hazardous waste <br />regulations. <br />Data <br />Printed/Typad Nama _ <br />Signature f <br />< <br />Month <br />J Day <br />Year <br />T <br />G., <br />T <br />17. Transporter 1 Acknowledgement of Receipt o1 Materials <br />j <br />Data <br />A <br />PrsntedlTyl odClame f <br />j <br />`� <br />Signat�ir�F 1; <br />Month <br />Day <br />ear <br />Nr <br />sI } I <br />t F; :: <br />S <br />�„ <br />r) I:, 1 I- '•e rf".` - <br />!.\y r {.�i..',s <br />�(f <br />F F €' - <br />IS <br />0 <br />16. Transporter 2 Acknowledgement of Receipt of Materials <br />Data <br />R <br />T <br />Printed/typed Name <br />Signature <br />Month <br />Day <br />Year <br />E <br />R <br />19, Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />20, Facility Ovrner or Operator: Certification of receipt of file waste materials covered by this manifest, except as noted in <br />item 19. <br />Date <br />T <br />Primed(Typed Name <br />Signature <br />Month <br />Day <br />Year <br />Y <br />CFid Ev' 2002 LA9ELi`lA5fFR8 (ttoa) s21 -seas www.labolmaster,com <br />SI <br />NK <br />=rrooH.¢ncmr�ucr, f <br />®� w•7n srra:,.�.e.a <br />