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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON—HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page 1 <br /> WASTE MANIFEST Document No. <br /> e of ti <br /> 3.Generator's Name and Mailing Address ' <br /> IVED <br /> 4.Generators Phone( ) <br /> I <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporters I `- <br /> 3 <br /> B.Transporter 1 Phone-. <br /> 7.Transporter 2 Company Name 8. US EPA ID Number <br /> D.Transp r.2.Done„T , <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Fa'c(lity'sIId'"', <br /> v F.Facility's Phone <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Writ <br /> No. Type Quantity WtJVOI. <br /> a. <br /> G b. t <br /> E <br /> N <br /> E <br /> R °' <br /> A <br /> T <br /> O <br /> W <br /> R d. <br /> Cl) <br /> aG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> N <br /> C3 <br /> cc <br /> a <br /> Q15.Special Handling Instructions and Additional Information <br /> Z .. <br /> O <br /> Z <br /> AWMMAVMMAffAVAWAWAWMJKMMAVM <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 /> Date <br /> Printed[Typed Name _ Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> N Printedrryped Name Signature Month Day Year <br /> F <br /> U 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L <br /> Date <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> F1402002 LABELAASTERO(800)621-5808 www.labelmaster.com PRINTED ON RECYCLED PAPER ruxrEum,x Rev.3/95 <br /> USING SOYBEAN INKISUNINK <br />