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IVOI`,iAZARDOUS WASTE MAN11,..,3T <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> 1.Generator's US EPA ID No. Manifest 2"PaT 1 <br /> NONHAZARDOUS Document 1,1p. <br /> WASTE MANIFEST 1=- = of <br /> 3.Generator's Name and Mailing Address <br /> 4.Generators Phone( ) <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transportees))ID <br /> S.TranspoAe}i;Pyoge ^•%. j`� ;i <br /> �C <br /> 7.Transporter 2 Company Name T 8. US EPA ID Number C.State Transportees ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.Stale Facility's 1D <br /> F.Facility's Phone - <br /> �ik <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity WL/Vol. <br /> a. <br /> z. T ;?L 1 f r._) r U•r ... T'r� f+., f" i� ..J r.,1 !J_J <br /> si <br /> G b. <br /> E t4 - it '7 ca 1_,rzc <br /> N • <br /> E <br /> R c. <br /> O <br /> W <br /> R d. <br /> F— <br /> t!! <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> U) <br /> � 1 <br /> a <br /> Q15.Special Handling Instructions and Additional Information <br /> 1 <br /> Z <br /> O <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 /> Date <br /> Printed/Typed Name Signature Montt-, Day Year <br /> T 17.Transporter 1 Acknowledgement o:Receipt of Materials Date <br /> R <br /> A Prinied/Typed Name Signature �; <br /> N _ { :jMonth Da.W Year <br /> P �-r ,L C f' >L.» '�^^V 1 I• • =•� <br /> O 18.Transporter 2 Acknowledgement ofr eceipt of Materials t Date <br /> •TPrintedrryped Name Signature <br /> E Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> -^t .�•--�• Date <br /> T Printedrryped Name Signature Month Da Year <br /> Y �ryy <br /> F-14 OD2002 LABELMASTER0 (800)621-5808 www.labelmaster.com Nxrrown Rev.385 <br /> r <br />