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WASTE MAUZARDOUSNY <br /> please print or type {Form designed foi'use on elite(12 pktch)typewriter). 2.Paged <br /> Manifest- <br /> NON»HAZARDOUS 1.Gennrato's US EPA lD No Document No of <br /> WASTE'MANiFEST:. '�.:=a ?^ �� <br /> 3.Generetefs Nameand,Mailing Address <br /> 7nif ie - 90114-1 <br /> 4.Genaratos's Phone( A.State Transporters ID <br /> n Name B US EPA kD Number <br /> 5.Transporter 1 Company - _ r� - - `:s = - •7� -. <br /> 3� L' TX 3 t ,,. Inc.. LT z3"3 `.91? 7:J B:Transporter 1 Phone <br /> 7.TranspoKer 2 Company Name - - ...8 .- - US EPA ID Number- , . - C.Stats TransporteCs kD <br /> D:Transporter 2 Phone= . - . <br /> 9:Designated Facility Name and site-Address <br /> 10. -US EPA ID Number - -E.State Facdits ID <br /> F Facility's Phone - 114- � <br /> 12.'Containers 13,Total Unit <br /> 11.WASTE DESCRIPTION Oiiaritity WL/Vol. _. <br /> No. TYPe' <br /> a. <br /> NO'l "-IVA7Wx ! WAST <br /> G b. <br /> R c <br /> T' <br /> ------------ <br /> j,l R d <br /> nH Handling Codes for Wastes Listed Above <br /> < G.Additional Descriptions I&Materials Listed Above;, <br /> 3. A3I3�t1azar au's wit-4r <br /> � i� eft }- <br /> 0 <br /> a:. <br /> Special Handling Instructions and Addidonal information S �c3 t k7C Cthh; �Cl ]f <br /> _- - 'ice(fit -e rzr'�r"r�T(j <br /> l- _TL.O r S -� 1�1J 3i1.+ r - <br /> L <br /> Z - = ►w <br /> �r <br /> GENERATOR'SCERTIF.tCATIDNi1 hereby certify that the contents 0f this shipment are lolly an daccuratelydescribed and are in all respects - <br /> in proper condition for transporL The materials described ori this mandest are not sublecf So federal hazardous waste regulations. - <br /> + <br /> 2±2 D Year' <br /> y.r '' Si nater <br /> Printo ypedNameall <br /> g - <br /> 1w �Date <br /> c <br /> 'T 17:Yransportei 1 Acknowledgement of.Reced of Materials. -, r _ - <br /> A <br /> 77;i Hat a Man 0 Year <br /> 9 <br /> P <br /> Name �•- - - <br /> Date <br /> A 1 B.Transporter 2 Ackn ledgemant of Receipt of Materials <br /> O_ Da Year' <br /> - -.Sr Hato <br /> re <br /> 'M 9' <br /> TPriniedlTyped Name ; 9 <br /> E , <br />! R ----------------- <br /> -19.Discrepancy'Indicatimi Space - <br /> X A ' { <br /> 20.Faafity,O_wrier or Operator Certification ah receipt of the waste matedals covered Gy ihis'manifest except as Hated m dem 19 "- <br /> L Date <br /> �..- Month - 'Day Year <br /> Si nature <br /> ^-'pnntedlT d <br /> Name <br /> 9 <br /> . YPe ' <br /> T _ <br /> Y - - <br /> F1402002 - AlBgp�¢21�i80B wv+wlaGetntautereom �wlnttmdtiittcrLAKiAASM <br /> ci>nvuFJt rwrm Rev,3195 <br /> �tS1 '-vswrrsOrBE►hiiwc - SOVINK <br />