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W <br />E - <br />(n <br />a <br />Cot) <br />D <br />O <br />0 <br />a <br />N <br />Q <br />Z <br />O <br />Z <br />NON -HAZARDOUS WASTE MANIF-dST <br />Please print or type (Fano designed for use on able (12 pitch) typewriter) <br />CF14 1i L BUAASMOD (eoq 6215668 www.labelmasteccmn - <br />.... ( wnsores.ro. lrR <br />NON -HAZARDOUS <br />1. Denounc's US EPA ID No. <br />Manifest <br />Document No./"k/jrb'-7 <br />2. Page 1 <br />I <br />WASTE MANIFEST <br />(-'JI(f/..I�l <br />of <br />3 Generators Name Mailing Address <br />T!l f <br />5✓ rl� <br />�j <br />V_` - Q `y�=j)�a <br />� ✓' I <br />4. Generatots Phone (ZO9 ) L 7 <br />Tre I pony me 8. US EPA ID Number <br />/ _%r <br />A. StateTransportersID <br />Phar <br />B. Transporter 1 Phone ,_7t �- �72 <br />_ <br />l"I nC�Co <br />N <br />T�t r <br />7. Transporter 2 Company Name B. US EPA ID Number <br />C. State Transporters ID <br />D. Transporter 2 Phone <br />9. Designated FatiFtyName 10. US EPA ID Number <br />/ <br />E. State Facility's ID <br />e, V_ <br />/ <br />F.Facility's Phone z'1 <br />.F <br />0 — (V�_ ) <br />.. <br />11. WASTE DESCRIPTION <br />12, Containers <br />13. <br />Total <br />14. <br />Unit <br />No. <br />Type <br />Quantity <br />WtNol. <br />'.. <br />a. (J�/ r r%?`'✓� Cid s ! ✓� fe�fi r e^(`tJ- <br />/ <br />E <br />N <br />E <br />R <br />o. <br />A <br />T <br />O <br />R <br />a. <br />G. Additional Descriptions low Materials Listed Above <br />H. Handling Codes for Wastes Usled Above <br />15. Special Handling Instructions and Additional Information <br />4,t &Ire <br />MAWAKMAWAKAKAWL <br />J AW AW AW <br />16. GENERATOR'S CERTIFICATION: I harebvddy that the contents of this shipment are lulu and accurately described and are in <br />N proper condition for transport- The mete is described on this manifest are not subject to hill?, <br />hazardous waste regulations. <br />all respects <br />Data <br />Prrnted/71 Name <br />J <br />Signature. � ice' <br />MonN <br />Day Year <br />T <br />17. 1 ranspoder 1 Ackrimtedgement of Receipt of Materials <br />Data <br />R <br />A <br />N <br />P(intedUYped Name - - <br />Signature <br />Year <br />PO <br />18. Transporter 2 Acimowledgemenf'of Receipt of Materials ' % <br />Data <br />TPrintedrryped <br />Name <br />SlgneWre <br />Monts <br />Day Year <br />E <br />R <br />. <br />F <br />19. Discrepancy Indication Space <br />A <br />C <br />I <br />L <br />W. Facility Currier or Operator, Certification of receipt of We waste materials covered by this manifest except es noted In Item 19. <br />- <br />� <br />Date - <br />T <br />PrintedRype l Name ._. <br />Signature <br />1 N <br />Day Year <br />Y <br />CF14 1i L BUAASMOD (eoq 6215668 www.labelmasteccmn - <br />.... ( wnsores.ro. lrR <br />