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a . <br /> NOR=HAZARDOUS WASTE MANI cST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS NIFEST � 33 Manifest n�/ 2.Page <br /> WASTE MANIFEST DacumeniNo. <br /> of <br /> 3.Generator's Name and Mailing Address /f 11 <br /> 4.Generators Phone(ZV?) EtSB-6z4D y �� <br /> 5.Transporter 11 Company Name <br /> � - 6. US EPA IIIDDD NNumber / A.State Transporters ID � <br /> [/ <br /> er B.T...,x 1 Phoni /37Ol <br /> ' <br /> ].Transponer 2 Company Name B. US EPA ID Number C.State Transporters ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> 11.WASTE DESCRIPTION 12, Containers 13. 14, <br /> TOWI Unit <br /> No, Type Quantity WVVoI. <br /> b. <br /> R c <br /> A ,f <br /> O <br /> W 1 <br /> jG.Additional Descriptions fgr Materials Lishi ove J H.Handling Codes for Wastes Listed Above <br /> O <br /> O <br /> cca <br /> 15,.Special Handling Instructions and Additional Information / <br /> o <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby rarefy that Me contents of this shipment are fullyy and accurately described and are in all respects <br /> in proper condition for transport.The materials described on this manifest are not subject to Faderal hazardous waste regulations. <br /> Date <br /> P realyped Name r gnatuDay Year <br /> S� Month r3 <br /> T 1].Tmnsp er 1 wledgement of Receipt of M erials <br /> R Date <br /> A Printed/Fyp me / Signatu Ment ay Y <br /> R11 1 D V <br /> S <br /> P <br /> O .Transporter 2 Acknowledgement of Receipt of Materials <br /> R Date T Primed Yped Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20,Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L <br /> I f Date <br /> T Printed/yped Name Signature <br /> Month Day Year <br /> Y <br /> F-1402002 LABELMAsrEve(Boo)621-560a ..labeima5ter.cam PRINIEOGNf1ECYCLEDPMR Rev.3195 <br /> ® IAING St iw Ow S INK <br />