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w <br />h <br />a <br />U) <br />0 <br />N <br />Q <br />Z <br />O <br />z <br />'e" AOWHAZARDOUS WASTE MANIPtST <br />(Form designee for use on elite (12 pitch) typewriter) <br />CF14 62002 IMFIAAf'fFA® (900) e215e09 wvw.labelmasler.can _�-- ^'""°�am�' µc 11°r" •-• <br />NON -HAZARDOUS <br />1. Generators US EPA ID No. <br />I <br />Manifest <br />Document Nor 7/ ` f75 <br />2. Pagel <br />i <br />WASTE MANIFEST <br />V C Yr ..// <br />d <br />3. Decameters Nam a� d Mailing Address � ✓4Y1( Y� <br />k4 <br />} n J k f o K �V 4 <br />i <br />"i <br />�r Av <br />4f rozl� <br />}fit Yi,l <br />Q <br />4. Generator's Phone ( . ) <br />5. T /.°rt.r I: y Nam .l <br />, <br />e. <br />/'U/S EPA I�D')Number <br />�'� , <br />A State Trerssporters ID <br />fWV�r <br />`-��L' llJ <br />B. Transporter l Phone <br />T. Transporter 2 Company Name 8. <br />US EPA ID Number <br />C. State Transporte's ID <br />D. Transporter 2 Pigne <br />9.99sgnated Facility Name and Site as , la. <br />US EPA ID Number <br />E. State Facility's ID <br />- <br />F. Facility's Phone <br />`t;C <br />11. WASTE DESCRIPTION <br />12. Containers <br />13. <br />Total <br />14, <br />Unit <br />No. <br />Type <br />Quantity <br />WWoI. <br />G <br />b. <br />E <br />N <br />E <br />R <br />A <br />T <br />O <br />R <br />d. <br />G. Additional Dewd to, for Materials Listed Above <br />_ Ili%IL <br />H. Handling Codes for Wastes Listed Above <br />15. Spacial Handing Instructions and Additional Information <br />16. GENERATOR'S CERTIFICATION: I hereby certify that 9w contends of this shipment are luir and accurately described and are in all respects <br />in proper condition for transport. The male als described on this manifest are not subject to ecleml haaardous waste regulatona <br />Dere <br />Printe rTyped9amI j }-- <br />Y _ !AY IY:�1�fl <br />V\ <br />Signature <br />Monlh -pay Year <br />c" Y, 17, <br />T <br />R <br />17. Transporter l Acknowledgement of Receipt of Male' 1. <br />IV <br />Del. <br />A <br />r <br />PdnteM t{}a�me - <br />Signatures" <br />Doy Year <br />S <br />C +rlJ <br />r <br />P <br />p <br />18. Trareporter 2 rawledgemeld of R I of Materials <br />F <br />pate <br />TPrinted <br />Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />F <br />19. Discrepancy IMio olon Space <br />A <br />C <br />) <br />M. Facillty�ner or Operator, Certification of receipt of the waste materials covered by this manifest, except as noted In Ilam 19. <br />Data <br />T <br />Print yped Name <br />CF14 62002 IMFIAAf'fFA® (900) e215e09 wvw.labelmasler.can _�-- ^'""°�am�' µc 11°r" •-• <br />