|
.. ._ .
<br /> -
<br /> ,= Al ZARDOUS WASTE MAN
<br /> -a N
<br /> .-
<br /> j-e * eWter
<br /> PI13ase=15rint or type .{{Form designed forlu�se on elite{i2 pitch)typ ) - Mande"si. iii q- r" - 2Page 1.
<br /> i��N-nAZAR�OUS - 1..Generata.".US EPA ID No,' , ? pocumont No, '�. I' �� if 7 of
<br /> tai +�1�, t '
<br /> WASTE MANifEST ' ..
<br /> 3.Generators Name and Mailixng Address ? - ti -,• �1�F'�a3 �: 3I sY��.tx'3': �' - - _
<br /> 4.Generators Phdna(' .A.State Transporters I10;
<br /> 5 Transporter t-Corhpany Name •, 8 U&EPA ID Number - { -�,.,
<br /> r, rz,frc
<br /> ` '33-.:'s 31 &Transporter 1 Phone
<br /> 6 - US EPA Ip Numher .C.State Transporter's 10
<br /> 7.Transporter 2 CompanyNameL. r. -
<br /> p.Transporter 2 Phone
<br /> 1.
<br /> 9:Designated Facility Name and Srie Addzess - 10 US EPA.D Number -E.State Facility s ID '
<br /> `ij�'} 1r., .jt!S:a '1"3.+ t`>�r F Faculty's Phona l _� a-_
<br /> ^^ f � , 6 ,,tea :n -* a 1-4-= r
<br /> "tn3 I•i,�, ,
<br /> 12 Containers 13- 14.
<br /> DESCRIPTIDN ; - A, _ Ictal : Unit
<br /> .11..WASTE 'Quantity" .t.
<br /> Qua .
<br /> -T. a dY•
<br /> . -•No: yp
<br /> -7--777�. � - ,:�.'-.''.%�-- : -� '- ,�-, ..:-,.. �,r— ..� � .,:� . - : �-:.... ". . ,..3, - , ,
<br /> a.,,
<br /> ,.).4_�IA_ �, t�-V J 7� -I A 1,7�-1 I T T D,I�- --, --�- - ,. I . �.,= � ..
<br /> G b
<br /> 1�'
<br /> 1,! -Se
<br /> E .
<br /> c. - ,
<br /> . 1 1.
<br /> A' .
<br /> O.
<br /> i.W' fl d
<br /><E...' r. _
<br />` a -H.Handling Codes for Wastes Listed Abova
<br /> -G Additional Descnptions for Mat9nals lasted Above.- -
<br /> ,-
<br /> �YC�3
<br /> O. t �. W 3
<br /> ,.P.d-.).
<br /> -I `_
<br /> Q.. 15:Special Handling lnstruaons and AddiLvnal lnformaUon' '�11D �•', "�` '�- ' . . � °-3C - ` - -
<br /> 3r ?iC���.j 'tom
<br /> t" r+ :_
<br /> Z` . ..-
<br /> I.
<br /> 16.GENERATOR'S CERTIFICATION:.I hereby certify that the.contents-of this shipment are fully artd arxurately dascnboo and ora mall respects
<br /> G proper condition-Sqr transport.-The matenals desenbed on this manifest a[e hal su37�ect to faders!nazardous,waste regulations 1. - }
<br /> _ �� _ x .(late
<br /> I JklmD Year
<br /> Signatuze a^,
<br /> PCInt Ff ped Name � a e
<br /> y r s fi
<br /> I Yh rl .'L. ''.pate-
<br /> a
<br /> ,0.''
<br /> .11 ferrels
<br /> emeM of Recei
<br /> of bla
<br /> ,_ T 17.,is spotter 1 Ackno.l P
<br /> Mont _ Y ar
<br /> L- I
<br /> P Name =-'.
<br /> fr rr r
<br /> r > �
<br /> P, .. Data.
<br /> F ; O 13.;ia11 er 2 Ackn edgement of Receipt df Ntatedais
<br /> R
<br /> Signature Month Day Year- t
<br /> T Pn 9G/fr Name
<br /> R
<br /> t9:biscrepancy'Sridieatfoh.Space _ - t- - *- _
<br /> A "
<br /> C
<br /> ve
<br /> regi this'rrianifast,except as noted In item 19",.,c - _
<br /> enols cc
<br /> rh6caLon of
<br /> revel totth
<br /> e waste mat bi _ .,
<br /> r tato[Ce _ P. . . .� 'r
<br /> I, pll OWrler e -.
<br /> _20rFa _ - _ _ _
<br /> - .. _ -.Date`-Y
<br /> L
<br /> t
<br /> i r� cr��.z - Maim, rear fi
<br /> f T PE. �t, l t- 1'hIt g ''' Signage k ! -!
<br /> .,..-- J-.`�� , , " , -, 'k %� % '
<br /> t I r i Revr. 3j 5'
<br /> I ,zF-14o?002 U1> 31�IASFER�i9P0)C2t�B08-wwwteE>elmest9rCom - �pRtnEnmiREcvg6nPu�t1 ■no.,r
<br /> ,, _ - .. " _ ,.... ._ --rLSMIGsover wxrx INK..-..
<br />
|