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NON -HAZARDOUS WASTE MANIFEST <br />Please print or type (F:rn, dcsigne_I for use on elite (12 pitch) typewriter) <br />CF14 9 2002 LABELNIASTER® (800) 621-5808 www.labelmaster.com 0 = <br />NON -HAZARDOUS <br />1-Geneffat�cs US:EPA ID No. <br />Manifest <br />2 Pagel <br />F_ <br />WASTE MANIFEST <br />Document No <br />of <br />3. GeneratoCiiiNqme end Mailing Address <br />4 Generator's Phone( 1 <br />S,Tfa�sppr;er 11Company Name _ ,,t( �'lt. �, ',r, o. US EPA ID Number .. <br />A. State Transporters ID <br />B. Transporter 1 Phone <br />7. Transporter 2 Company Name B. US EPA ID Number <br />C. State Transporter's ID <br />D. Transporter 2 Phone <br />�t�d Facility N ani tl A ss 10. US EPA ID Number <br />1'r�yfZvVii <br />E. State Facility's ID <br />r <br />20241Prms Ai,r ntln <br />F. Facility's Phone <br />1�,� / <br />t-t,MiviA1'; A44!rrr.i <br />11. WASTE DESCRIPTION <br />Containers <br />13. <br />14 <br />_ <br />Total <br />Unit <br />No. <br />Type <br />Quantity <br />Wt./Vol. <br />,,;$.1a'V i ? l tt -,i,E II :i 1 1.': i ?�i:l _ •'.t: t 1�,1 3 P j.it, :°�,j�4i:ts <br />G <br />t' — <br />E <br />N <br />E <br />R <br />` <br />A <br />T <br />0 <br />R <br />d. <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed Above <br />F'•If:�:ar:.P ?�Nty1�li►t `t 1 ?tis <br />I <br />15. Special Handling Instructions and Additional Information <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 />Date <br />PdntedrTyped Name <br />Signature <br />Month Day Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />R <br />A <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />N <br />S <br />P <br />O <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />Date <br />R <br />T <br />Printedrryped Name <br />Signature <br />Month Day Year <br />E <br />R <br />1 <br />F <br />19. Discrepancy Indication Space <br />A <br />L20. <br />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 <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />CF14 9 2002 LABELNIASTER® (800) 621-5808 www.labelmaster.com 0 = <br />