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r <br /> f <br /> NON-HAZARDOUS 1 Gen_grotor's US EPA ID No Manifest 2 Page 1 <br /> WASTE MANIFEST � <br /> 3 Gen atpr' Ngrtte and M�ng[Adc�retss <br /> `-J I JJh 10 -t' is <br /> 4 Generator's Phone( ) <br /> 5 Tran ort/e/f[yI Company(/[Y},Iy/+',�rQe 6 &PA <br /> Number A Transp/oyrter's Phorn/^e /9 / <br /> 5'Y�'�J J � <br /> 7 Transporter 2 Company Name 8 US EPA ID Number 8 Transporter's Phone <br /> 9 mated Facility ome and Site A jdrT, r � 10 US EPA ID Number C Facility's Phone <br /> 1 I Waste Shipping Name and Description 12 Containers 13 14 <br /> Totai Unit <br /> f No Type Quantity Wt Vol <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> to <br /> R <br /> d <br /> Additional Descriptions for Materials Listed Above E Handling Codes foc Wastes Listed Above <br /> A/)PAe d V --/ 6 n o C P <br /> 15 Special Handling Instructions and/+dditional Information Y <br /> Cjt✓ !f ✓ J 1' d f -X r +' -y .} l 1 rs . 'Z c y.. C 1� E�f ►� <br /> C, b J' (�"h, s.a.i, f r t• t LS (.ir'k 7'C4 C, <br /> � `.) A•y{ C+r ' df v { <br /> 16 GENERATOR'S CERTIFICATION I certify the moterials described above an this manifest are not subject so federal regularions for reporting proper disposal of Hazardous Waste <br /> Printed/Typed Nor r �Signatura: 'w _-"µ��_�A Monr�h Da Year <br /> T17 Transporter 1 Acknowledgement of Receipt of Materials <br /> NP iniad Tygf�Nam�/J Signay�re` Y Month DaK� Y�1 <br /> S <br /> p18 Transporter 2 Acknowledgement of Receipt of Materials <br /> =­tul. <br /> Month Day Year <br /> T Printed/Typed Name <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> Facility Owner or Oper for Cerhficati n of receipt of waste materegls covered by this manifest except as noted in Item 19 <br /> ! r1 r <br /> Y S <br /> Printed/Typed ed/Typed Name � � � � ( g � / / ! � / Mon!` ayj ear <br /> TRANSPORTER# 1 <br />