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- GENERATOR NON-HAZARDOUS WASTE MANIFEST
<br />(Continuation Sheet)
<br />19. Generator ID Number 20. P ..e._ 21. Waste Tracking Number
<br />3&-fi - I il 1 (XX) I 2-
<br />22. Generator's Name (A ) k./.e.
<br />' ,3tbe-L4a. 4 . Cil a 51-31, ?3,5 E giffl 9- -
<br />23. Transporter_ Company Name _. 3
<br />U.S. EPA ID Number
<br />_ L1 /46 .-rntA,ig--)ni -rizthot-1 /4. LL.C. I etitL(tui 2 5 -5 2- i U.S. EPA ID Number
<br />24. Transporter Company Name
<br />26. Containers 27. Total 28. Unit 25. Waste Shipping Name and Description No. Type Quantity Wt.Nol.
<br />Received
<br />"\--pin 2 zuzi
<br />GHD
<br />Indianapolis
<br />711a REFEtizirpr,
<br />To W. lv,•,s ItEc--r.- i'ER.krrs GR, ' - vr oR Rats,. iElv.
<br />m -•-• 1-1-AN .7/ Pir, To 7-•:-• , •-• CROS DLEo a ov,_ 4 ivri sysaRoNv _ "- ., r -,-..-z oEr:. .K7ofv, i ile REsouRce ' z`• ; AL s•:.:,:••,-,.:.--.. ' RTMENT • ,;(?), Irxv Ar7,._.1, .:,.,,,,__.EDEitAl '9> '' sCLI,AN-.3E.`v'''''... -• , •
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<br />Special Handling Instructions and Additional Information TRANSPORTER Transporter al Acknowledgment of Receipt of Materials
<br />Printed/Typed Name
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<br />,
<br />S' moth
<br />1 [r+
<br />Year
<br />Transporter Acknowledgment of Receipt of Materials
<br />Printed/Typed Name Month Day Year Signature DESIGNATED FACILITY Discrepancy
<br />170-BLS-C 6 10501 (Rev. 8/06)
<br />
<br />DESIGNATED FACILITY TO GENERATOR
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