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low <br /> ' • - _ ,. _. <br /> M1N1 AZARDOUS WASTE MAN T' <br /> Please print of type (Form designed for.usa on elite(12 pitch)typewriter) <br /> 1,Geriarators US EPA D No- -,�. Manifest, `� 2 P - <br /> NON-HAZARDOUS -� '- r Document No" bt <br /> WASTEMANIFEST' <br /> -1Ge6eratoils-Name,And Mailing Address <br /> .Generators Phone <br /> 4 <br /> 5.Tr iter 1 Company me, Number A:State Transporters ID <br /> ,. -.- .. . '� -- 6 US EPA <br /> ID Nu '" <br /> r f� i3,Transporter 1 Phon .77 <br /> e ' <br /> 7:Transporter 2 Company,Name , 8. US EPA-10 Number C:State Transporters ID <br /> 'D.-Tra6sporter 2 Phone <br /> signated.facifity Narne and Site Address' i0 _ US EPA ID Number E State Pacility's.tD <br /> ..if $ l <br /> F.'Faci!' s Ph ne• <br /> 11.WASTE DESCRIPTION- .'•12.' Containers 14. <br /> .13.' <br /> Total Unit <br /> Type Quantity-, wtJVol. <br /> a: <br /> X., <br /> b. <br /> E <br /> d. <br /> N <br /> E <br /> I US,' R <br /> ., <br /> Q G.Additional Descriptions for M Is Listed Above - - H Handling Codes for Wastes;Listod Above <br /> 0. : ':::: <br /> GC - <br /> 15.S al ndling Instnicfions a rid do I!n rm on. - <br /> z0, 1 c/ f <br /> ACO AF AV. <br /> fti. <br /> GENERATOR'SCER hereby certify that the contents of this shipment.are fully and acdurately d scribed and are in all respects <br /> in proper condition for fransporL'The materiats:described on this,manifest are not subject to faderal hazardous waste regulations: <br /> Date <br /> Prihted/Typed Name Signature Y Yea <br /> 17,Trarisporfer 1 Acknowledgement of Receipt of Matenals <br /> 1 A- Pri ed ante , Signature th Yea <br /> s <br /> ` -p' 18"Transporter 2 Acknowledgement of Receipt of Matgrfals.:.� -..„ - - <br /> TPrintetlfFyped Na3ne''" Signature Month Oay Year. <br /> R. $ <br /> •' 19"Discrepancy Indication Spacer- <br /> F <br /> r 20.Facility Owner or Operator Certificatiotfof receipt of the waste matenals covered'tiy this manifest except,as noted in item 19 ` ? <br /> 1 T Priitted?TypedI a Signature �lonflt.'""Day Year <br /> r Y <br /> �F <br /> 14 0201)2 eft.,R6PRrtart1:10 ori PFGYgF09MFA - iR ro wi _ 1Rev 3195 , ' <br /> soveE+wlrllc INK _ ., <br />