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NON-HAZARDOUS 1. Gong of /s S EPA ID No. Manifest 2. Page 1 <br /> WASTE MANIFEST r!V/ Document No. of <br /> 3. enerator'sName and ailing Address <br /> ck�aw 5'ee7 <br /> 3 03 Z t S-1�C�>`��. CO9�Ze�3� i <br /> 4. Generator's Phone 5—[/ <br /> 5. Tran rt 1 Camp an e 6. US EPA ID Number <br /> 7. ransparter 2 Company Name jB. US EPA ID Number <br /> 9. p/��si/g�ngyf�ed F flliity�N�ame,and Site <br /> Address •���,,,JJ 10. US EPA ID Number A. Transporteh Phone <br /> w�"/� �/�'QK- � y� B. Transporter's Phone <br /> /s7 T O LrItf,,, /�� + C. Facility's Phone <br /> lvil Csr . ZJ-7-t,--& <br /> 11. Waste Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt Vol <br /> a. C�� s ✓a J� a�� <br /> G b. <br /> E <br /> N <br /> E '. <br /> R <br /> A c <br /> T <br /> O <br /> R <br /> d. <br /> D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes listed Above - <br /> 15. Special Handling Instructions and Additional Information <br /> 16.GENERATOR'S CERTIFICATION: I c.mfy the materiels described above on this monif" are not subject to federal ragulofiom far rsocniq proper dispawl of Nasardom We". <br /> Printed/Typed Name ;7 Si naNre Month Do, Year <br /> /aay 9 /.Z I If IF 2 <br /> T 17.Transporter 1 Acknowledgerni,06 o Receipt of Materials <br /> R <br /> N Printed/Typed Name Si Monrh Dar Year <br /> S <br /> p18.Transporter 2 Ackn.46heident of Receipt of Moteriols <br /> Lnntd/Typed Na Signoture Monts Dai" Year <br /> 1 <br /> Discrepancy Indication Space <br /> y Owner or Operator:Certification of receipt of waste materials covered by this monifest c pt as noted in Item 19.d/Ty d Name Signature Monrh -.Day Year <br /> �c kr e r S ra - <br /> ! ORIGINAL—RETURN TO GENERATOR <br /> I <br />