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AHAZARDOUS WASTE MAAST <br /> Please Patio,type - (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS Generators US EPA ID No. Manifest 2.Pagel <br /> • .WASTE MANIFEST Dpppme N6ni C12 _0t5_, of 0 <br /> 3.Generat1o�r�s Name lead MaiITff Address - C_.,4!y qq �ih <br /> Aew WP;r C;'frc10 o, 10101 Ric -i ��-P'\ l�' P7 -t^��t•z1Y <br /> 4.Generators Phone I 1 (�' l (A <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporters 10 <br /> B.Transporter iPhone 70-- 37 • % <br /> 7.Transporter 2 Company Name 8. US EPA 10 Number G State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Fatility,Name and Site Address 10. US EPA ID Number E.State Facility s ID <br /> INC <br /> _,WC V F.Facility'a Phone <br /> �40 11M CA <br /> I1.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wi <br /> a i �h <br /> !7 11)jZM <br /> i_ttl <br /> IG d. <br /> E <br /> R <br /> A <br /> T <br /> O <br /> W R d <br /> H <br /> V) <br /> Aridltional Descnptions for Materials listed Above H.Handling Codes for Wastes Listed Above <br /> C;9b2- l� <br /> O <br /> 7n;5 ! MtAo <br /> cc <br /> Q <br /> Qt 5.Special Handling Instructions and Additional Information <br /> Z <br /> 0 <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby certity,that the contents of this shipment are fully and accurately described and are In all respects <br /> I n proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Pndted/rypad Name Signature Monlh Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> N Printad?yped Name ,( `I i 1 SignaNre / Month Day Year <br /> p18.Transporter 2 Acknowledgement of Reekooffulaterials Date <br /> T Printed/Typed Name SlgneNre Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20.Facility Owner or Operator:Codification of receipt of the waste materials covered by this manifest.except as acted in item 19. <br /> L Date <br /> T Pratetllryped Name Signature Monfh Day Year <br /> Y (�-�rcpigd E �rhreilE7=* '. )U 2 l <br /> F-1402002 LABEAASTFRO (800)621-5606 www.labetmereer.com A T.— Ray.395 <br />