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W <br />I— <br />>Q <br />7 <br />0 <br />0 <br />Q <br />N <br />Q <br />x <br />z <br />0 <br />z <br />NOIR -HAZARDOUS WASTE MANIFveST <br />. .caiavViin <br />an aIW 1. a.. .........y.......... �....�.. ...... a._a.......a <br />NON-HAZARDOUS <br />.ir—.....�. <br />1. Generator's US EPA ID No. <br />MO niifestnl� ' <br />2. Page 1/ <br />WASTE MANIFEST <br />Of <br />3. Generatuts Name and Mailing Address -[ ,� <br />c' <br />�l?(il�Y✓I VL S <br />"v <br />ffA <br />Cts 952I� <br />5�} k+,, <br />. <br />4. Generators Phone (yo=,) L1 i 7 — I'l <br />. Tm r 1 Compaur^ryJup(me(�f e <br />7 G.� 16l, <br />US EPA ID <br />Ta.D <br />A. State Transporters I05 <br />B. Transporter 1 Phone <br />Z Transporter 2 Company Name 8. <br />US EPA ID Number <br />C. State TrerlsponaYs ID <br />D. Transporter 2 Phone <br />"grated IF IT Name and Sit A � 10. US EPA 10 Number <br />E. State Facility's ID <br />�a✓tr �..Qj; r / <br />F. Facility's Phone <br />2� <br />11. WASTE DESCRIPTION <br />12. Containers <br />13. <br />Total <br />14. <br />Unit <br />No. <br />Type <br />Quantity <br />N%Nol. <br />c WAD <br />S/ <br />G <br />In. <br />E <br />N <br />E <br />R <br />e <br />A <br />T <br />O <br />R <br />d <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed Above <br />15. Special Handling Ins lions and Additional Information <br />-4w AW <br />AW <br />16. GENERATOR'S CERTIFICATION: I hereby caddy that the contents of this shipment are Will and accurately described and are in <br />In prgner condition for manepoM1 The materials described on this manifest am nwt subject as federal hazardous waste regulations. <br />all respects <br />Data <br />Printer Nem <br />Signature <br />hf�lh y Year <br />! <br />� <br />T <br />17. Transporter 1 Admowladgement of Reeeipl W k4shanals <br />,y. <br />Data <br />R <br />A <br />i <br />P <br />Pdntedrr N /'— <br />i3r� r f'r on <br />Signature <br />y Year <br />�/ r <br />O <br />18. Transporter2Acknowledgentent of Receipt of Materials <br />Date <br />TPdnhdR <br />N <br />Signature <br />Month Day Year <br />E <br />R <br />. <br />F <br />19. Discrepancy Indication Space <br />A <br />C <br />I <br />M. Facility Owner or Operator, Can tion of receipt of the waste materials <br />l by this manifest, except as noted N item 19. <br />L <br />I— <br />i <br />I <br />Date <br />T <br />Pilmod/Typed N <br />Signature <br />/ oM y Y er <br />Y <br />r <br />v v <br />CF14 02002 l/JEIiTI Ila (M) 621 s90e www.labekn er.com rs.m n..wvr <br />rnIM1Il <br />