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W <br />Cn <br />a <br />U) <br />ryry� <br />0 <br />a <br />a <br />N <br />a <br />X <br />z <br />z <br />NON -HAZARDOUS WASTE 1?A;N=1F1iJVED a <br />Vpo , „y„o ..',,. <br />NOWHAZAR DOUS <br />r......, . ---- <br />1. Generator's US FpA ID No. <br />n st <br />Documen W. <br />WASTE MANIFEST <br />J37.Generators <br />Name and Mailing Address Ado -e G,( V eo 04 C. ' TY Ung .� <br />IE=;l.� <br />) N M ENTAL <br />"421 0 A- ` <br />Pis��I2 <br />DEPARTMENT <br />hod: <br />4. Generator's Phone (;2Qy ) r 7 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />fi/✓n,►+. C a e,,,� ; a' e00007 � 0 <br />A. State Transporters ID <br />' <br />c7 <br />B. Transporter 1 Phone g 6 (� - 33 3 � 2_7 <br />7, Transporter 2 Company Name 8. US EPA ID Number <br />C. State Transporter's ID <br />D. Transporter 2 Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />vs E�aerp�y A e4 ff�/,yf �.✓� <br />r <br />E. State Facility's ID <br />7 r-'r"� y q 1 � � a”' r C S 1 <br />c7&1�; �✓ 33opcUPJUC� <br />hone <br />F. Faculty's Phone <br />0 31 q3 <br />&e_-4v��J <br />11. WASTE DESCRIPTION <br />12. Containers <br />13. <br />Total <br />14. <br />Unit <br />No. Type <br />Quantity <br />Wt./Vol. <br />a. /)VI '�ta ZGr drJvS j/(/4S �G j��I• (]r SO' l Lvf}'k�S <br />;Z Li <br />G <br />b. <br />E <br />N <br />E <br />R <br />A <br />T <br />d. <br />a <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed Above <br />15. Special Handling Instructions and Additional Information <br />�> A 0 tel - v.3 �,J7Uc 2 0011-1 _3- SYA�, <br />16. GENERATOR'S CERTIFICATION: I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br />described on this manifest are not subject to federal hazardous waste regulations. <br />in proper condition for transport. The materials <br />Date <br />Printeci typed Name Signature Month Day Year <br />T <br />Date <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />qPrint6 <br />yp d Name <br />:SIgnat Month Day Year <br />CU <br />N:::] <br />S <br />P <br />O <br />I . <br />19. Transporter 2 Acknowledgement of Receipt of Materials Date <br />T <br />PrintedlTyped Name Signature Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C20. <br />Facility Owner or Operator; Certification of receipt of the waste materials covered by this manifest, except as noted in item 1 f1. <br />L <br />Dale <br />T <br />Pr' t ypod Name/Signal <br />th ay <br />Y <br />_ <br />�flWFDIXNECTUE0IM£Pi�i•__:.m�� <br />CF14 1 ® 2002 LAB A.SMO (800) 811-5808 www.labalmaster.com W <br />