Laserfiche WebLink
LLJ <br />F— <br />a <br />0 <br />a <br />a <br />N <br />a <br />z <br />0 <br />Z <br />NO H-AZARDOUS WASTE MANIWST <br />Phase nAm or tune (Foem declnnwl fer nae M -life <br />CF14 0 lAlEl7SIASTFA® (aep(62Ide0a www.tebelmas .core ® w: "`er.oE. rA. <br />NON -HAZARDOUS <br />GeneeewsUS EPA ID No. <br />DocpmaniN . <br />DocuManiment <br />2 <br />WASTE MANIFEST <br />`V!�(C//� <br />age <br />3,lj�)�gnergtor's�ryne aVJ .1 <br />X44.. <br />n cC <br />Gene e72toP33PPohne (W )VAG/Jrr <br />. <br />1waspiam�a� 6 US EPA ID <br />,VT/ �V <br />nspaPhoneD <br />S. Transporters I <br />7. Transporter 2 Company Name B. US EPA ID Number <br />C. Slate Transporters ID <br />D. Transporter 2 Phone <br />g��.j7ew9noted Fad ty N e at¢Site Adtlrass / / 10. US EPA ID Number <br />��I <br />E. State FaGIgYs ID <br />F. Faclli s Pn <br />7 <br />i % h C11/ f5zl S <br />LSC � 9cg�- /�`Z51 <br />11. WASTE DESCRIPTION <br />12. Containers <br />13. <br />Total <br />14, <br />Unit <br />Type <br />Quantity <br />WWa. <br />r� y� <br />'^No. <br />G <br />b. <br />E <br />N <br />E <br />R <br />G <br />A <br />T <br />O <br />R <br />d. <br />G. Additional Descriptions for Materials Usted Above <br />H. Handling Codes for Wastes listed Above <br />1S. Special Handling Instructions and Additional Information <br />If. GENERATORS CERTIFICATION: I hembv.My Mat Me contents of this shipmem are lolly and accum=desaibed and see In <br />in proper condition for transport. The mate aIs d==^tbed on this manifest are not subject to Imfeml hiscre a male regulations. <br />all respects <br />Data <br />Printed?yped re t <br />Signature <br />h ( y Year <br />T <br />17. Transporter 1 AclanoafedgemkInt of Receipt of Maled s <br />Data <br />APrint <br />I <br />N m <br />c, rr (H <br />Signature <br />M Oay Year <br />z/ !/ <br />o <br />.5 <br />F <br />O <br />18. Transporter 2 Acknowl gement of Receipt d M enals <br />Date <br />R <br />T <br />E <br />PtntediTyped Name <br />. <br />Signature <br />Month Day Year <br />R <br />F <br />19. Discrepancy Indication Space <br />A <br />C <br />( <br />L <br />20. Facility Owner or Operator, Rcallon of eacelpt of the waste materials covered by his mandest, except as re, in tem 19. <br />- <br />( <br />Data <br />T <br />Pdnl typed Name <br />Signature <br />y <br />Y <br />l <br />CF14 0 lAlEl7SIASTFA® (aep(62Ide0a www.tebelmas .core ® w: "`er.oE. rA. <br />