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A.-HA <br /> RDOUS WASr MASEST <br /> Phase print or'type (Form oe neo for Lisa pn stn (12 plteh)type <br /> NON-HAZA DOUS 1 Generator'& S EPA ID No. Man fest <br /> WASTE M (FEST Dooymeni No. Page, <br /> 3.Generator';Name and M ng Address I of <br /> 4.Generators Phone <br /> i S.TrikhapOrter i Company US l`cPA iD Nu r <br /> A.State Tran&portar'6 ID <br /> B.Transporter t Phone <br /> i 7,Trarlsponer 2 CoJ"re <br /> 8, US EPA ID Num ar <br /> C.State Tran&porter'a ID <br /> D.Transporter 2 Phone <br /> a 9.Designated FacilitSite Address 10. US EPA ID Num E.State Facllty'�I17 F.FacllnysPhone <br /> 11.WASTE DESCRIPTION <br /> j 12. Contalrlera 13, 14. <br /> Total Unit <br /> No. Type Quantity wt./Vol <br /> 1 s. <br /> G b 7r <br /> } E <br /> N <br /> E <br /> ' R c. <br /> A <br /> 0 0 i <br /> CQ tl. <br /> G.Additional Deacriptiona for lerlala Listed Abov <br /> H.Handling Codes for wastes t Iated Above <br /> i <br /> I I <br /> i I � <br /> 1S.Special Handling Insiructior and Additional Into ation <br /> -MAWAFAVAM A M MEW M AV AW MM AV AV <br /> 16-GENERATOR'S CERTIFI TION:I hereby cert ty that the conten r116iripment are 1WIy end aocuratel died and aro In all respects <br /> In proper contlnlon for tra rt.The malenals cribed on this manot wNectto federal hazard a to regulaGonc. <br /> i I )ate <br /> ( <br /> Printed/Typed Name Signature <br /> y Month Day V <br /> l T 17.Transporter 1 Acknowledge,ent of Receipt of Mj Iteriale, ' ate <br /> A Prhtedrtyped Name Signature <br /> Monm Day Ye <br /> OOpP 1S.Transponer2 Acknowledge ant of Receipt of M terlale ate <br /> T Prk ted/Typed Name Signature Month Day Y <br /> 9 <br /> F 19,Discrepancy Indication Spa <br /> i <br /> 20.Facility Owner or Operator; ortification of recelpi of the waste rnat8j Is covered by this merNtest,except as in it,,,10. <br /> L <br /> ate <br /> T PnntedrTyped Name Signature Monflt Day Y <br /> eaY <br /> CP'r. asaw —eecref-Tery (soo)82,•.000. .lab9rmaster.com ®wrtee ar4C•Ftc I' <br /> �I ZB 39Vd NOOV39 3NI-1NV719 BTSSZ6860Z £S :ZZ 600VTO/61^I3 <br />