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NON-HAZARDOLIS WASYE MANIFEST <br /> Please print or type , (Form desk;ed for use on elite(12 pitch)typewriter) <br /> NQN-HAZ R— DOUS I.Generators US EPA M No. Manliest <br /> WASTE MANIFEST DocumentN z.Pagel <br /> _ _ ;� T � of <br /> 3.Ger:eralar��s^^'Name and Mailing gddress <br /> cb=E1V —�— �+j <br /> r <br /> 4.Generators Phone( l'� ) r •O ! -s"^i f�l e-} 1.. <br /> . 5.Transputer f Company Mame 6. US EPA ID Number - <br /> y� A.Smta.Transpartcrs[0 <br /> h- <br /> 7. <br /> 7.Transliorter2 Company Name ' <br /> 6. US EPA ID Number C.State Transporters ID <br /> I <br /> . D.Transporter 2 Phone <br /> 9.Designated Facility Ntame and Site Addregs 10- U$EPA ID Number <br /> E.State Facility's to <br /> I ltz C^ p <br /> {r-(*.s F�,Facflity's Phare <br /> 11.WASTE DESCRIPTION 12. Corttalners Tocol 14, <br /> Na. Type Quantity WtIvol. <br /> a <br /> T�Jr�- I�Z1zr>4. {s £�(� T_yG .. crytti �isjrs �rF�Ct, 'Tr-,t. � <br /> C7 b. <br /> E <br /> N <br /> i E <br /> R c. <br /> A <br /> T <br /> O <br /> W .R d. <br /> ( a <br /> rte. G.Additional OesCHP>Ions for Materials listed Above H.FiandGn4 Codes for Wastes Listed Above <br /> r� N <br /> flU i?FYI r <br /> ( a <br /> Q15.Spada;Handing lnstrwhons"Adrilional ln(ormalon j <br /> j .ri.. { "' :� �r '"j w:-.:—•� S iSt7.�"'G�. A- L.40-114ra i j i - <br /> z <br /> i <br /> j 16.GENERATOR'S CERTIFYCATION:I berehy certify thet the contents of this shipment are rutty end accurately desCrLed and are m all respects <br /> in Proper condition far transport.Tho malerials described on this mareest are not subjep to federal hazardous waste Fegulations. <br /> Date <br /> PriModTypod Name Signature - <br /> t Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Reeotpt,of MaYo6als Date <br /> R <br /> ` Pri"wrypird Name Signature Month Day Year <br /> N <br /> 0 18,TrAnapodar 2 Aplaldwledgemant Of Receipt of Materials <br /> Data <br /> ER Pdrtedrr Name 51 nature <br /> ' YP� 9 Month flay Year _ <br /> R <br /> I19.Diacrepartry Indication Space <br /> s F' <br /> 1 A <br /> f C <br /> ! 1 20.Fatality Owner or Operator.Cera foatfon of receipt at the waste materials covered by this manitest.except as noted In item 19. <br /> L Data <br /> I <br /> T Pdmed/TYpar1'f me i Signature t / F Month Day Year <br /> i— <br /> Yfl (�ii i14liT�- :I 5 L <br /> t F.1402002 LICE ®(BOD)621.6648 w w.W)elmaster.com rawrED pt aEcrLiE7 vu�t t.wrr Rev.3195 <br /> Il w MY'SOYDEM wlr <br /> a <br />