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NON-HAZARDOUS 1. Generator's US EPA ID No. Manifest 2 Page 1 <br /> WASTE MANIFEST . - . <br /> Document No. °f j <br /> 3. Generator's Name and Mailing Address <br /> 4. Generator's Phone <br /> 5. Transporter 1 Company Name 6. US EPA ID Number A. Transporter's Phone <br /> .1 'J V sr.i Ii <br /> 7. Transporter 2 Company Name 8. US EPA ID Number B. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone <br /> 11. Waste Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt'Vol <br /> Y <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 /> +.1 ;J321 of iVATEi?&%Lr17.x}iu7'4 i+JL'.E t itOm PAINT LINE � <br /> 15. Special Handling Instructions and Additional Information <br /> i•1GiF'. '• ,L-;^k'i <br /> -1-62-427-7277 <br /> �.{='=;`t r(�E.Itt'=;+ 'NT =_ BILL fC t=t+h"i�J9J(1'�C-hlTrt.�3Er i"ivLFZ'(SErZ11iC'�::i':r �s .i�f :r�1:.i. :�t,' cC;� <br /> 16.GENERATOR'S CERTIFICATION: I ertify the materials descril2pt,abo"se�on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Printed/Typed Names i1 t y s Signature-f ', i 1 Month Day Year <br /> L <br /> - '� _ ; _�.� , t : U."?1 �- <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> APrtQted/Typed Name �, Signotur7, �+ ��� �' y Month Day Year <br /> $ _ :est s r_l � ' f lu U►5 —'l t :( ��s'.".r i �n t� <br /> P 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20.Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in Item 19. <br /> 1 f <br /> T <br /> Y <br /> Printed,,Typed Name f' Signature 1r-V~��—'�- Month, yDo y 1 Year <br /> 1 a+'T✓'G-�.b�' �r�� i'7'rY c�' -..:f1.'1" <br /> TRANSPORTER# 1 <br />