Laserfiche WebLink
^t 1 DONS WAST.MA[�:_.cT <br /> NC,- . A .. <br /> P4ease print or type (Form designed for use on elite(12 pitch)typewrit6r).� - 2.Page 1 <br /> Manliest <br /> NON-HAZARDOUS ,.Generitoes;US EPA ID No..1 Document No of <br /> WASTE MANIFESTS ,53 251 <br /> 3,Generators Name and Mailing Address y u '� `��y sf�i tLr: t5► . <br /> :52(3 •Sii,ilatret� <br /> a.Generators Phone( ..373 264-5?�' <br /> 5.Transporter 1 Company Name 6. US CAT. <br /> ID Number A.State Transporters ID <br /> CAT 1330 141 �Y3... B.Transporter 1 Phone <br /> ��z 't��. Tr.��►.�, lac. � .. <br /> .g. US EPA ID Number, C.State Transporter's ID <br /> 7.Transporter 2 CompanyNameD.Transporter 2 Phone <br /> US EPA IDNumber - - E.State FaciliYs Ip. <br /> 9:;Designated Facility Name and Site Address <br /> 32= 0 O t r,.3at3r a treat ^ F.Facility's Phone ! 44i-X731— 307 <br /> Aaahal.t,. , . 92 5 FsC � '7 . <br /> 12- Containers. 13. 14. <br /> h 11.WASTE DESCRIPTION _ - _ Total Unit <br /> No. Type Quantity Wt.Nol. <br /> a. <br /> G b. <br /> N <br /> E,. 1 <br /> R c. 1` <br /> Rd. <br /> W - <br /> r <br /> H.Handling Codes for Wastes Listed Above <br /> G.Additional DescripVons for Materials Listed Above <br /> l <br /> t - <br /> T- <br /> jC x� <br /> tructro sand Additional Iniormatron ,- <br /> N special Handling Ins n <br /> 5 ec <br /> 15 P 9 - .. <br /> .aLt3iITS ' J" LF it <br /> Z :... � #9409-3,39— <br /> d <br /> 9439—557 . s <br /> 16,GENERATOR'S CERTlF1CATION:I hereby certify that the contents of this shipment are fulNy and accurately described and are'in all respects <br /> in proper condition for transport-The materials described on this manifest are not subject to federal hazardous waste,regulations. <br /> Date <br /> Pdnted/typed Name Signature Month •"nay Year <br /> s' <br /> Date <br /> TR 17.Transporter 1 Acknowledgement of Receipt of'Materials <br /> Signature Month Day. Year <br /> A PrintedlTyped Name - <br /> r S <br /> P Date' <br /> i8.Transporter 2 Acknowledgement of Receipt of Materials <br /> • R <br /> signature <br /> Month Day Year <br /> T PnntedlTyped Name <br /> ' <br /> R <br /> 19.Discrepancy Indication Space - - <br /> F <br /> A <br /> 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted In item 19- - <br /> .L - _ Date' <br /> T <br /> Month Day Year <br /> PrintedrTyped Name - - Signature - <br /> I Y. <br /> Rev.3195 <br /> F-1402002 U13ELAAy ER�(BOO)6215101 ,,ww.W.4ma.I..c0m. ., - -�PAINTEOONRECYCLEDP►>Eafir,,rmntewrr - - . <br /> ��wcaw rwr ILrJ/crnrur <br />