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NL�AAZARDOUS WASTE MAL T <br /> Pleas ni or type (Form designed for use on elite 02 pitch}typewriter) Manifest 2.Page 1 - <br /> NON-HAZARDOUS 1.Generators US EPA ID No. Document No. of — <br /> WASTE MANIFEST u <br /> 3.Generator's Name and Mailing AddressC 7." ?at �ajll3r aaty I <br /> `j1ifit~4 ,;.a-3t3ra rxir3 A. �c.1 <br /> 4.Generators Phone( �} A.State Transporters ti) <br /> 5.Transporter 1 Company Name 6. US EPA ID Number - <br /> ��• i!',,,�jT .11313 "�1 2 '� 8.Transporter t PhoneLix ?At 1 <br /> B. US EPA ID Number C.State Transporters ID <br /> 7.Transporter 2 Company Name D.Transporter 2 Phone <br /> i <br /> US EPA)[)Number. E.State Facility's ID <br /> 9.Designated Facility Name and Site Address 10, r <br /> ,�� 1yvir� a1tZ �. <br /> 32 � 'r�xt r rL t F.FaclitySPhone M-533-21;17 , <br /> 1:1.337 13. 14. <br /> 12. Containers Unit l <br /> 11.WASTE DESCRIPTIONTotal Wt Not <br /> No. Type Quantity <br /> I <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> � d. <br /> W <br /> aIT Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above <br /> dwtar <br /> cn <br /> N 15.Special Handling Instructions and Additional Information • 91G'3 { J� C; � <br /> I,yViY E:�� 4...'1♦ 9.5 LA-! <br /> Z <br /> Z .an. .3! -g3 —.5a7 <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully 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 /> pate <br /> Signature Month Day Year <br /> PrintedfTyped Name <br /> Date <br /> T 17.Transporter 1 Acknowledgemerit of Receipt of Materials <br /> qPrintedlTyped Name Signature Month Day Ysar <br /> N r"1 <br /> P 18.Transporter 2 Acknowledgement of Receipt of Mate6als` _t Date <br /> R <br /> R Signature Month Day Y@ar, <br /> T Prirnedlryped Name <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <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 pate <br /> Signature Month Day Year <br /> T Printed/Typed Name <br /> Y <br /> F-14 C 2002 I.A WAASTER9(W0)6215806 www.0 bdmaster.corn ®PR,NTEe oN RECYCLED PIPER e,.,co w,rx - Rev.3195 <br /> USING SOYEEIN ttM $1;fY 1NK <br />