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_.fit _ •� F _ . <br /> NON-HAZARDOUS 1.Generator ID Number T1_,Rage 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST "`�►7 ? '}`i n51 <br /> i '? --�• ? , <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 51'1-1, :.3,v La �2 :-oU R'Dad <br /> Generato?' a yr `..'- :`_";,x 9521- <br /> 4 6.Transporter 1 Company <br /> �Naame U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> If <br /> S.Designated Facility Name and Site Address U.S.EPA ID Number <br /> facil' dria� ri W, :a �3 7 � ;`�11 ,537-13151 10 20 39:3 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,-Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> No. Type Quantity WtNal. <br />' HM and Packing Group(if any)) _ �= � <br /> Li'd 3 f °:ower A;" 2 x <br /> �P <br /> W <br /> W 2. w <br /> 3.. *% t <br /> :W <br /> 4. <br /> 13. Special Handling Instructions and Additional Information <br /> j 77 yy �y 4tr�rr�� <br /> 14.GENf.RATOR'S CERTIFICATION:[certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Signature Month Day Year <br /> Genemtor eroes Pgr�lgdr�Typed Name 9 <br /> e�� <br /> z._ <br /> 15.ImemaAional Shipments ❑Import to U.S. ❑Export from'U.S. Port of entry/exit: <br /> y <br /> Tran' rter S' nature fore its on Date.leavin U.S.: <br /> x 16.Transpontysr AcknDWedgment of Receipt of Materials ; f <br /> Transporter 1 'ntedRyped,Name) f." Signature i' Month Dai Year <br /> ✓b 'N11< .� fi� 1fr 'r� '� !:• ..">.�'^�, ` i.. -•. ��.i! <br /> caMonth Day Year <br /> Q Transporter 2 PHrL yped Namg Signature <br /> F .. _ <br /> 17.Discrepancy 7 <br /> 17a,Discrepancy IndicatlDh,Spatia ❑Quamily ❑Type El Residue' ❑Partial Rejection ❑Ful{Rejection <br /> .: <br /> Manifest Reference Number.' <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> rat. Fadlitys Phone: <br /> 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 4 u <br /> Fn <br /> Lu <br /> 16.Designated Facility Owner or Operator.Certification of receipt ai hazardous materials covered by the manifest except as noted in Item 17a <br /> PrintedlTyped Name Signature Month Day Year . <br /> iao_rai rr.n 1; 7n498 GENERATOR'SISHIPPER'S INITIAL COPY <br />