Laserfiche WebLink
NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 71-�­,er.tor'sUSEPAIDNo.aManifest 2.Page 1 <br /> WASTE MANIFEST Document No. <br /> f of <br /> e atodsName MaPin d s1 <br /> dary W, <br /> a 4.Generator's Phone <br /> 5 Trans orte�,11Com ani Na -46,. <br /> e ## 6. US EPA I .Nu �.,,,,} sig A.State Transporter's ID <br /> ~ � 3.1,,ir iT4 +S.a�i� le ,4M £i <br /> B.Transporter 1 Phone <br /> 7.Transporter Company Name 8. US EPA ID Number C.State Transporter's ID <br /> D.Transporter Phone <br /> 9 Desi not d F cili Name a d Site Address 10. US EPA ID Number E.State Facility's ID <br /> 1s sf a� <br /> F.Facility's Phone <br /> 11.WASTE DESCRIPTION Containers 13. 14. <br /> Total Unit <br /> No, Type Quantity Wtivol. <br /> G. b. <br /> E <br /> N <br /> E <br /> R e. <br /> T <br /> O <br /> R d' <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> D <br /> a <br /> :-� 15.Special Handling Instructions and Additional <br /> N k' 0WACA U" <br /> a <br /> o <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 /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Data <br /> Printed/ryped Name Signature Month Day Year <br /> � 14,ra <br /> w <br /> TR 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> NPrinted/Typed Name Signature Month Day Year <br /> P <br /> R 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> EPrinted/Typed Name Signature Month Day Year <br /> R ' <br /> F 19.Discrepancy Indication Space <br /> A <br /> C <br /> L20.Facility Owner or Operator:Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> Date <br /> T Prtnted/Typed Name Signature Month Day Year <br /> Y <br /> CF14 02002 LABEtMASTFR® (800)621-5808 www.Iabeimasteccom ®­­­��re �"KT yINK <br />