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OUS WASTE MANS., _,, ' �, .may. al. ..f. <br /> N( ,� F ►ZARD u <br /> Please print or type. (Form designed for use on elite({2 pitch)typewriter) 2"'page 1. <br /> Manifest <br /> NON-HAZARDOUS 1.Generators US EPA ID No. Docuflieni No. <br /> WASTE MANIFEST CO-9.31 YJS `251 <br /> 3.Generatof's Name and Mailing Address - » " . •• - <br /> .i1 sifi�1 4a_3tara Gn)cera — Xtta: P:A- �:iz11�r Lwt�l <br /> `3��U 3'3?1�3 SrYn t, <�4%..aarC�, '01. 9UU740 <br /> 4,Generators Phone( <br /> 5.Transporter 1 Company Name t7C.. -AT 6. u5 EPA ID�Number A.State Transporter's ID <br /> ;3� ' �:3't ir:�=13, .La ` tl l� tj 2 .� 6.Transporter1Phone 9U'4 � � <br /> 7.Transporter 2 Company Name 8. US EPA M Number C.State Transporter's ID <br /> D.Transporter 2 Phone r <br /> 10. US EPA ID Number' State Facllily's ID <br /> 9.Designated Facility Name and Site Address - E. - ' <br /> t F_Facility's Phone <br /> 32tJiI L. Fr�1�tara :qtr � 114-53U-73J7 <br /> A L�ilai:a, X7.:3£3 ' C:1L JUU ?Jtl . 0 <br /> 12.' Containers 13r 14- <br /> 11 WASTE DESCRIPTION - - - Total Unit <br /> No. Type Ouantity <br /> Z © ��' <br /> Th7:JS ".d 9 r L 11 EDS <br /> E <br /> ' A <br /> LU R <br /> a '= <br /> ',G.Additional Descriptions for Materials Listed Above - - H.Handling Codes for Wastes Listed Above <br /> N 15.Special Handling Instructions and Additional Information J:i� Sita:ta: St jxktaa Facilit jr - <br /> a - <br /> 1,?,)U, iC,daI1 ?,A <br /> Z, <br /> r <br /> 16.GENERATOR'S CERTIFICATION:I hereby c"ty that the contents of this shipment are fully and accurately described and are in all respects <br /> '.in proper condition for transport.The materials describedonthis manifest are not subject to federal hazardous waste regulations.' <br /> i Date <br /> I <br /> 72 Day Year. <br /> Sign r�f�, <br />• Prin[edlfyped Name � �^� � �"� ''^� - !�O <br /> L/ <br /> T '17.Transporter 1 Acknowledgement of Receipt of Materials _ ! pate - <br /> R Slgnafu Month Day Year <br /> 4 N Pnnte ed Name <br /> p18.Transporter 2 Acknowledgement of Receipt of Materials- - Date <br /> T Printed(Typed Name Signature _ Month Day Year - <br /> E <br /> R <br /> i 19.Discrepancy Indication Space - <br /> i F <br /> I A <br /> 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manliest,except as noted in item 19. - <br /> L' - - - - - Date _ <br /> T PrintedlTyped Name Signature Month Ray Year <br /> EiEI y <br />! F-1402902.. L/RELMASTFR®(600)621-G606 www.'tWnimagercom M.irtE,, REcCLEOPAPER�n�.i[�ur . .Rev.3195 <br /> rmwrs mwcw fur ��I L���JJh!! <br />