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NONHAZARDOUS Ganaralar'l US VA 10 No. Manifest I 2, pope 1 <br /> WASTE MANIFEST +T f �orlyir4or,�t No:l <br /> J. Gonarafar's Name or,d Ma, V' <br /> - IingAddress '1.'j"! ;'h'• s ' `.`;'i� +'x'7�.'rr.rf" T,+`71:s.;�i �•1 "s�'^r9 <br /> r.�,?� Y.t� L';'F� }-r-�:Yp�r\'� r`i�/ 'S'�� F•Pr Y.Itt s i. s <br /> r 4. Gcnorofor's l:bano <br /> I3, Tron:por3ar } Company Noma <br /> '�.. <br /> � uy,l b. US EPA 10 Nvmber Ij <br /> f lj, el. ,4 <br /> 7. TrornPprtar 2 ComaOny Namo 9. - Yrr-- <br /> US EPA Ip Numbor <br /> 9. Dasfpnolod Fociilly Noma cnd$ilp Address 10 <br /> - . <br /> . US€?A I0 Numbar �� F A. TronsPorlor's P 'j.?T�Cr <br /> 2717 (r. 9_irdrti0ortpr's Phano <br /> P?ICTUlDt CA n :j �I C FaciM y PFane <br /> --- --�, ' (�1 LSF? 40-ter:W <br /> 11. WaCto Shipping Namo and Coscripfion �P IZ�Canfainors 19, f It. <br /> VNo. T Total Unft <br /> a _ Typo Cuanl!ty� <br /> E � <br /> T <br /> Ft <br /> i <br /> �, Add;rlanol Cestrlulions for!ngser:7ls Li,!cd!.'oove N4n6linQ Codas lar Yeas+el listed Abavt <br /> IIA. <br /> (S"x"� i�'f'�r�[�i":'� �t��fr'iI,'?�'1�,, �;�.. �•^'c'r � i''', r <br /> ly, 5ps:ciaf Handhny In;lruc!icns and Ao'di+ionai lnformarioni-.__-- <br /> i <br /> ti �.r ;i� l 201 :a�1.��,c ,.•ri 9r,2()7 ' <br /> r <br /> I6.GENEitATaR'5 CERTIFiCAT10N- rinrCrScti ?CarC at Tll noniraf} ;rc net wbjcv fe tedcral rngu!c-lonj fqr raCaerimg pfppgr -,tiPoral of fjarordowj Wasfo. 1 <br /> PrintadlTYAad Nana � - <br /> s7�711'i Moruhf y. Y� Da rar <br /> i{" ' rl /tel'` r �•r. �(: �,a; <br /> 17.Tron9oDFlcr 1 Aclsnowlcdoorncni of P"CrDr� of Mwtricls hyped Nome { � -�--•• - - - ......-..�—,_....W,...._.� I <br /> N /� r }c a r' Signatura Gayor <br /> Month Y ; <br /> p J <br /> 0 118.Tronsoorfor 2 Acknowledgcm.>nj of PC:Cip+of�saitrials r I` k 1 <br /> T Printed/T ed Nome <br /> E YA Signotura Manrh coy Yoor <br /> R <br /> 19.Discrepancy Indication SFact �1 <br /> F �. <br /> A <br /> L 10-Fccifily Owner or Qporatar: Carrificatitn a! raccijsl of waste materials;ovarcd by Ihis mpniloa oxtopr!as nottd�in Item 19, <br /> I <br /> I <br /> T _ <br /> Y -_— - -'. y -�-. -- <br /> Prinled/Typed Ncmgj / ! ! / Signalu;o :^ ii Month Day Yoor <br /> f_,'� I i r 1 J j <br /> l / <br /> Li <br /> ' `IY <br />