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N( -HAZARDOUS WASTE MAR .ST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1.Generator's US EPA ID No. Manifest 72. ge 1 <br /> Document No. <br /> WASTE MANIFEST <br /> 3.Generator's Name and Mailing Address <br /> _a3iiar3 ils taas iia}.us <br /> 4.Generator's Phone <br /> 5.Transporter 1 Company Name ` "" 6. US EPA ID Number A.State Transporter's ID <br /> B.Transporter 1 Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> F.Facility's Phone <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt.Nol. <br /> a. <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> R d <br /> W <br /> H <br /> I G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> `I <br /> M <br /> Q <br /> Q <br /> Q <br /> Q15.Special Handling Instructions and Additional Information <br /> 1 <br /> Z <br /> 0 <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 respects <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> I <br /> I <br /> Date <br /> Punted/Typed Name Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> A Printed/Typed Name Signature Month Day Year <br /> S <br /> P 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> TPrintedlTyped Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> 1 <br /> 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L <br /> Date <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> 1,; 2002 LABELMASTEA® (900)621.8808 www.labelmasleccom r�rcoax�mc�o ru[n <br /> uswc soeuuixc SINK <br />