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i. <br /> i <br /> NON-HAZARDOUS WASTE MANIFEST <br /> 9 <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> I NON-HAZARDOUS <br /> t7!��t.rs us EPA ID(:o. Manifest2.Page, <br /> 3 Documeent No. <br /> 1 WASTE MANIFEST Aov <br /> 3.Generator's Name and Mailing Address 4,. - <br /> 1 " IDE FV L CN n V G 3 fir, <br /> t A.Generator's Phone{ 1 - )3�% --'Y, <br /> (. <br /> E <br /> S.Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's ID <br /> j�w�J�c r.'•7'" f itj - B.Transporter 1 Phone 70-7-3714•-�,¢•_YJ <br /> ' 7.Transporter 2 Company Name B. US EFA ID Number C.State Transporters ID <br /> D.Transperer2 Phone <br /> 9.Designated Facility Name and Site Address 't0. US EPA ID Number L S.Ste Facifity's ID <br /> s <br /> X4 40*vwl RD F.Facility's Phone A n <br /> 11.WASTE DESCRIPTION "12. Containers 13. 14 <br /> Total Unit <br /> r No. Type Quantity WtNol. <br /> f <br /> I G <br /> ! E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> R d. <br /> UJ <br /> i a G.Additional Descriptions for Materials Used Above H.Handling Codes for Wastes Usted Above <br /> O w .. <br /> ❑ <br /> a <br /> t Q 15.Special Handling Instructions and Additional Information - <br /> Y <br /> Sr,HM "�1'AWE TAL m <br /> HPEALTH EEF"�,ATRAEN <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respe:ts <br /> in proper condition for transport The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> ! <br /> ' Date <br /> { <br /> Prinled�T ped Name Signature Month Day Year <br /> 10 <br /> T 17. ransporter 1 Acknowledgement of Receipt of Materials Date <br /> ItIP R <br /> €€ q Printed• Yped Name Sig:•mao;re Month Day Year <br /> E H <br /> S. S <br /> 0 IS-Transporter 2 Acknowledgement d Receipt of Materials Date <br /> RPnntedr ped Nams Signature Month Day Year <br /> 1 R C'lrrP ^ T i <br /> 19.Discrepancy Indication Space <br /> F <br /> 1 A <br /> i C <br /> I 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this man'rtest,.except as noted in item 19. <br /> 4 E Date <br /> T Printed/Typed Name Signature Month Day Year <br /> .. F-1 a m 2002 LAME A SEER 9 (800)521.5606 w ww.iabellrnaster.corn .,,,,,rc w„w .. Rev.V95 <br />