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: 191 r_•'.-. i� A .. <br />NON: HAZARDOUS WASTE' MANIFEST ; <br />Please Prem of Ivos FOTm'aes0ted Tai uee an cam t,c <br />NON -H" <br />iu.�,J' yyewr w,r <br />1. Genaratara US EPA. ID ! m. <br />Manifest' <br />renl Na. 2Lftg�0 <br />WASTE MANIFEST <br />3. Genaralce4 Name -and Matting Address t�LiYt wi M >?C!2 f* 7j% 2 <br />Irv -4 <br />R IZGtN <br />4. Generators Phone <br />5. Ttansporlerr I Company Name 6. US EPA ID Number <br />A State Transporters ID <br />B. Transporter i 'Phone <br />G <br />Y D 2 i 0" i^+u_ V <br />7. Transporter 2 Company Name a. US EPA ID Number <br />C. State Transporte's'ID <br />D. Tranapbrter 2 Phor:6 <br />B. Designated Facility Name and Site Address r, 1o. US EPA.ID Nuinber <br />E. State Faeiflty's ID <br />'F. Fadllws Phone , <br />' <br />i 1: WASTE DESCRI PTION . <br />12 Contatnem <br />'13. <br />Total <br />14. <br />'Unit <br />No. <br />Type <br />Quamlty . <br />WINd. <br />Non►=- r1A2 Qan G+ WPiTC`R.. <br />E <br />R <br />d. <br />G. Additional Descriptions for Materials Listed Atwve <br />H- HandlIng Codes tar wastes Listed Above <br />.- <br />�]/iUWr',J a �7N�j! nip UDDYt <br />' <br />15. Special Handling Instructions and Addldonai information <br />16. GENERATOR'S CERTIFICATION: I horabyr aertity'that the contents of this shipment arefuf{y and' accuratdly described arid are in all respects <br />on <br />In proper cTitian for transport. The materials described on-ihis. manifest ate not subject to federal hazardous waste regulations. , <br />Pats <br />PrintedIlAmd Name .Signature <br />Month ,. <br />Im <br />Day Year <br />TT. <br />17. Transporter 1 Acknowledgement at Recelpl of Materials <br />pig <br />A. <br />' PttntedlTXW Name <br />sf re <br />- Mdrfh ' <br />Rey ' ..Year <br />p.. <br />L <br />p <br />18. Transporter 2.Admowiedgement'of Receipt of MaterialsT <br />pate - <br />PdrnedlTyped Name <br />Signature <br />Month <br />Day Year, <br />. '. <br />•R <br />19. Discrepancy Indication Space <br />i <br />2o. FacVy Owner of Operator, Certification a1 raoefpt cf the waste materials covered by Ws'manitest,,oxc-A as noted in item 19. <br />i <br />Data .' . <br />T <br />Y <br />.. <br />Printedfs yped Name <br />Slgrtature <br />M" <br />, Day Year, <br />1 <br />F14®2002 l.A9F.L?$ASM0 (860)521.5808 wxw-Iabeliraster.cum <br />