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Y.. ANT.. <br /> N��AZARDDUS.WASTE M: <br /> Please print or type {Form designed for use on elite(t2;pitch)typewriter}, - _ =PagoManifest <br /> NON-HAZARDOUS 1-Generators US EPA ID No. - pocument No. 5?"!i -1 <br /> WASTE-WANIFEST (4D q375-13 251, . <br /> - - 3.Generate s-Name arid Mailing Address - <br /> 3 hstar a 1racer3 .'kt A ��t Gat1;,3r t <br /> iii Stvan,) Uaaiarca <br /> 4.Generators Phoria( .323)- - <br /> 5.Transporter,l Company Name - 6. - USIEPA ID Number `, A.Stats Transporters ID - <br /> �:3.+ '4=1t X.iS23� B.Transporter lPhone r <br /> 7.Transporter 2 Company Name '- B. --US EPA ID Number - - ;C.State Transporier's ID <br /> D.Transporter 2 Phone . <br /> -10. <br /> g,Designated Facility Name and Site Address - ,US EPA Ip Number E.State Facility's 10 - <br /> x <br /> R .F : w..r ree t. F.Facility's Phone <br /> 32� <br /> r <br /> w <br /> a a� <br /> 7 <br /> . 12.'Containers 13:.. 14. <br /> 11.WASTE DESCRIPTION ,. - - - Total. Unit <br /> - No. - TYPec- .. Qu <br /> an' Wt1Vol. .. <br /> a' <br />�I N. <br /> I� <br /> C. <br /> A , <br /> W R €.' <br /> I N_ <br /> Additional Descriptions for Materials Listed Above ., _ H.Handling Codes for Wastes Listed Above <br /> CA; <br /> O .10F CLE 4.14-1 I E-11-059; <br /> { <br /> N 15.Special Handling Instructionsend.AdditicnalSnfarmatlon J-15 y-Ita:- 7�t�Ctt0a facility- _- <br /> Q <br /> Z GLIV;S Y" a"71L.P. <br /> O <br /> 16.GENERATOR'S GERTFF]CATION.I hereby certify that the Contents of this shipment are fully and accurately described.and are in all respects - • -in proper conciltion for transport.The matenals described on this manifest are not subject to federal hazardous waste regulations. <br /> Data <br /> PrintoctTyped Name- ,1 Signature Month Day Year. <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials j° Data =. <br /> R Prin ey atma� / Signatur Month Day Yea <br /> P 18.Transporter 2 Acknowledgement of Receipt of Materials - _ <br /> O Date . <br /> R Printed(Typed Name Signature Month Day Year <br /> T <br /> E <br /> R <br /> 1g.Discrepancy Indication Space <br /> F <br /> C <br /> 20.Faoility Owner or Opeiator,Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. - <br /> L Date <br /> T Printed/Typed Name Signature Month .-Day Year <br /> f <br /> Y <br /> F-1402002 NBUAATTER (800 621 5808 www.labelmaster,com RBV.3195 <br /> ) PR NTEe ON RECYC1EbP!PER �rwr rro w,r� <br /> ® USn+GSOYBEAN 1trrtSUM1/INK- - `f•c:.,: <br /> e-a h <br />