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W <br />W <br />a <br />N <br />O <br />G <br />CC <br />a <br />N <br />d <br />z <br />Z <br />NON-HAZARa4US WASTE MANIFEST <br />Please print or type (Form designed for use on elite (12 pitch) typewriter) <br />FROMINNININ <br />NONHAZARDOUS i eGenerators US EP ID Na. Manifest,� 2, Page 1 <br />WASTE MANIFEST aLAF tH 1 S Document No. i-),591V,K of <br />t a and Ma81ng Address <br />Mel V*Ah li *Ws AWAD <br />Manx CA sS�dli .., <br />a. Generemra Phone ( 2Qijeo�M6� 02,46 X 257 <br />5- Transporter 1 Company N 8. US EPA fl{ r A. State Transporter's ID <br />Ad%mr� dirftil6ol l �1t'►tipt3Ct hb, (9m L ?(1f11.17t1 8, Transporter I Phone �tlZi-S�ldS- (i�►{i <br />7. Transporter 2 Company Name 6. US EPA ID Number C. State Transporteea ID <br />D. Transporter 2 Phone <br />Iprla WMl o and Site Address to. US EPA ID Number E. Stare Fackltys ID CrAl" WO <br />�t A F. Fadlity a Phone <br />11, WASTE DESCRIP'T'ION Cantalaars 13, 14o <br />Total <br />Nov Type Quantity Wt,Noi. <br />Y <br />G NON HAZARDOUS WASth, SUM <br />E <br />N <br />E - <br />R <br />A <br />T <br />0 <br />R d. <br />G, Addilional Descriptions for Materials Ustad Above H. HandlIng Codes for Wastes foisted Above <br />I)ER A;1030 <br />XRGO; i t}383 <br />15, Special Handling Instructions and Additional Information <br />16, GENERATOR'S CERTIFICATION: I h,ereby car* that the contents of this shipment are ItAy and accurately described and are In all respects <br />in proper condition for transport. The notedais described on this manifest are not subject to federal harardow waste regulabom. <br />Date <br />Printed/Typed Name Signature Month Day Year <br />T 17. Transporter 1 Acknowledgement of Recelpt of Materials Dale <br />vessel <br />N Printed/Typed Name , Signature,,.. Month ,1?ay Year <br />0 18, Transporter 2 Acknowledgement of Receipt of Materials Dara <br />TTPrinted/Typed Name Signature Month Day Year <br />R <br />R <br />F 19, Discrepancy Indication Space <br />A <br />C <br />L20. Facility Omer or Operator: Certification of receipt of the waste materials covered by this maNfest, except as now In Nem 19, <br />' Date <br />T Printed/Typed Name Signature hwm Day Year <br />Y <br />