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ARDOUS WASTS►_ <br /> NO�. AZ E MAN <br /> , <br /> please pant or type (Form designed for use on elite(12 pitch)typewriter) <br /> Manifest 2.Page 1 <br /> NON-HAZARDOUS 1.Generator• US EP ID N No. J� <br /> of <br /> WASTE MANIFEST <br /> 3.Gen'Wo�s ``CAMailing Addrass� 6J <br /> //``►► � %r+ '���/Q�/- �O L <br /> 4.Generator's Phone(32—,3) 2&W� <br /> 5 T sporier 1 Company ame 6. U EPA ID Number A.State TransportePs ID <br /> Zf�4i R.Transporter f Phone <br /> 7,Transporter 2 Company Name 8. US EPA ID Number C.State Transporters ID <br /> D.Transporter 2 Phone <br /> signaled Fail ty Name and Site Address 10, US EPA ID Number E.State Facility's tD <br /> F.Fa'city's Ph ne <br /> 001- . f 650 2:397 <br /> 11.WASTE DESCRIPTION 12. Containers Total Unit <br /> No:. Type Quantity Wtivoi. <br /> a. <br /> E REMEDY ENVIRONMENTAL SERVICES OniX <br /> N accepts Non-mmirdous water/excluded recyclab111�11ermt WNW 6F L"xn.11pp� <br /> le= <br /> E <br /> R ` oont#ilae>}t6'4Yogaii�a <br /> A <br /> T TOW <br /> O d. <br /> LIJ <br />� QS G.Additional Descriptions fair Nj°terials Listed Above H.Handling Codes for Wastes Listed Above <br /> TS 0 - 36 <br /> IM <br /> 15.Sapcia!vandlinq instructions 3WAddjliopal lyo on <br /> C/.fin � <br /> 1;- ��•�! <br /> Z .� <br /> Z ��5 <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in ail respects <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations- <br /> :DalePrintedrryped Name �� �� Signature / � YB <br /> c,ENN `-J <br /> T 17,Transporter 1 Acknowledgement of Receipt of Materials a Date <br /> R <br /> Ap tw Signature Mon Q Year <br /> S <br /> P r <br /> p 18.Transporter 2 Acknowledgement of Receipt of Materials � 'Date <br /> TPrinted/Typed Name Signature Month Day Year <br /> F <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> E 20,Facility Owner or Operator,Certs kation of receipt of the waste materials covered by this manifest,except as noted in Item 19. <br /> L Date <br /> I Slgn ure t' Month Day Y <br /> r <br /> T Prin[edf!y Name ( o <br /> Y (' i6al � lr V 'L <br /> F-1402602 --LA LAASTER9(800)e2I-&808 www.11811e1masl9rcam �PIUNTE0pr1aEGYCIEDPApEfi .r;oM,� Rev.3195' <br />