Laserfiche WebLink
Please Dri,t of tvea <br />NON -HAZARDOUS WASTE MANIFEST <br />(Form desioned for use on aRe f12 pitch) typewriter) <br />CF14 02002 LA8F2MASfERo (BOD) 821 <br />NON•HAZARDDUS <br />� � <br />Manifest <br />t No nor <br />� <br />�' .�" <br />WASTE MANIFEST <br />3 i y a rr� and MEOV Address <br />i <br />2261 W"hicxsWan Acis. <br />GA85201 <br />264-3311 <br />4. Generators Phone <br />Trete i 2 fS 1 /na k 8. <br />US EPA tDs) rntyWit 1, O5O <br />4.P1lFMJfJfIIIJa'll1 <br />A. State Tmnapotter's ID <br />- <br />_ f'"''• lAvj <br />S.TrattapOrterlPltorte <br />7. Transporter 2 Company Name B. <br />U3 EPA ID NUmbar <br />C. State Transpoder's ID <br />D. TransporW2 Phoria <br />MR Name end Site Addrou 10. <br />US EPA ID Number <br />E. Stale Fecli tys ID �19MO <br />.. <br />:go <br />• AriK l <br />F. Fackys Prada <br />nom- r?.AaA335 <br />11. WASTE DESCRIPTION <br />Containers <br />13. <br />14.TOW UrA. <br />No. <br />Typo <br />Met" <br />Vk Not. <br />2ARMI a <br />Cm <br />G. <br />b' <br />E <br />N <br />E <br />R <br />A <br />T <br />0 <br />R' <br />d. <br />G. Additional Dem"ons for Materials listed Above <br />H. Handing Codes for Wastes Listed Above <br />Projoc:t Numbu 49654 <br />:. <br />1jERGl ;1CIM PCC - <br />15. Special Handtlnp Instructions and Additional Information <br />M AVM <br />AWMAVAN <br />AN SEA <br />- <br />1& GENERATORS cERTIFI AT10N I hey certify that the contents this sldprnent are (alit end accurately described areInallrpei»cie <br />federal hazardam <br />in proper mrxAdon for transport Tiro materials descd od on this manifeat are not subfact <br />to waste ati� <br />Dale <br />' <br />— — -Month <br />P ypad Name <br />6Fgnattxe <br />t <br />'.Day <br />/year <br />T <br />17, Transpodar 1 Aclmowfedperneni of Receipt of Materials <br />Date <br />A <br />PrintedrTyped Name <br />Bipnaturo <br />Year . <br />S.� <br />0 <br />I& Tmnspodw 2 Aclaovrtedpment of Receipt of Materials <br />Dole ' <br />RT <br />Prlmed/Typed Name <br />Sfgcwfurs <br />Mornh <br />Day : 'Year.,: <br />HE" <br />19. Dinaepancy irxHcation Space <br />F. <br />A <br />C <br />( <br />20. Facility Owner or Operator. Certification of receipt of the waste materials covered by this manifest, except as noted In hem 18. <br />L <br />� <br />Hata <br />T <br />PdMad/Typed Nairn <br />SlpnpttaY _ <br />Month <br />Day Year:. <br />Y <br />. <br />-5808 v+wyv.labelmester.com <br />