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r � �� cST: <br /> ' .r TE.MA .-.. <br /> AS . <br /> - "ZARD� <br /> USW . <br /> Please print ar type (Foorm'designedfor use'on inks(,12 pdch)typewriter) <br /> "NON-HAZARDOUS'�Yr�.ARDOVS 1 Generator s U5 EPA ID No.,' Manifest y 2 Page 1 <br /> WAST£MANIFEST ' z"!?-, <br /> xDocument Na <br /> 3.Generator s Name and Mailing Address <br /> J;11�'F.i�' � �� 'a��Z'3 •�r.}x.,.'.r3 lgl4r�l :�3'i., 's'.iL�.� 'r� .�'' - . <br /> �omaar��, <br /> 7.`!_ .� <br /> J.WU� <br /> }., <br /> Phdne - <br /> 4' enerators - <br /> .G <br /> f. <br /> A.State Transporter's ID.°Y <br /> US EPA ID Number PR <br /> srteri Company Na _ <br /> - 5.Tran Y . <br /> - r - - - . F <br /> .._ ,'�3Z' :�3� -LT'�31ay -L7� � u����R,�'��'.:•�� S.)�J B.Trarrsporter'1,Phone ,,' <br /> 7.'Transporter 2 Cornpany.Name B. US EPA M Number - G:State Transpogt es ID <br /> D-Transporler4 Phone <br /> 9._Desrgnatetl Facility Name and Site Address 1D,. US EPA.lD Number E State Fac lily s Id--;aa—Y FavirS-�,ia'A'aC <br /> 3_200 �'. Frj;z r�r a. T•r?:'� F Facilitys Phorse <br />' ' ' �.'><a'�uz��i., �;:�. �"'�}�. _ �aL: �)Jt1 •�f.fi1 .5)fJ' 71.f-a-�3J-7'?�37 _ <br /> 11.WA5TE DESCRIPTION', <br /> i2 '•Containers, '; 13: 14.';; ` <br /> Total Unit . <br /> No. Type auantily WldVot. <br /> G. b !. <br /> A <br /> Additional Descriptions fol Materials Listed Above H Handlrng Codes for Wastes Ltsled Above 1 <br /> titer, <br /> CA <br /> a0 ' �, ?fit} 'I ' t11—7051) a <br /> Q '6 i75 <br /> N 15:Special Handling Instructions and Additions[Information , ,' 7, 1 t'�: t�C C L a'n, <br /> 7- <br /> F3C 1 <br /> IN <br /> f O f <br /> d 1B..GENERATOR'S CERTWICATION:-I,hereby 6willy that ttie contents of this shipment are fully.and accurately described and are In all,respects <br /> in proper coadrtt�for transport The materials described on this manifest are not subject to federal hazardous.waste regulations <br /> r Date' <br /> Prints ygad Name / :_ Signaturer' ��j '� Month Day Year <br /> �'/ <br /> T .17.Transporter 1 Acknowledgement of Receipt of M terials % Date <br />+ q Bri a ped Name Signatur - 4Jw h 'Day Year <br /> P - - / 6 <br />{ O 18.Transporter.2 Acknowl-dgement of Receipt of Materials Date € <br /> r R Ij <br /> T Printedff d Name; Signature _ Month Day 'Year. <br /> R <br /> i 19.Discrepancy Indication Space <br /> P <br /> - 20.Facility Owner or Operator,Certification of receipt of the'waste'matenals covered by this.mandest,except as noted in dem 18: <br />! L <br /> ' Date <br /> 'r' PrintedlTypedName _ Srgnafure _ 'Month Day Year' <br /> - <br /> :F1.4 -wnvwlabelme8tercom - _ MUHfEDONRECYet1:DPAPEn u.reorrr . . `.±. Rev 3195 <br /> � ;� usarc sore�w iNir J Snrr Irutr -''i <br />