Laserfiche WebLink
NUIv-HAZARDOUS WASTE MANLrtST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1.Gener[a[xttoi's US�EPA IDNo. Manifest 2.Pagei <br /> k,r.9b. jali .� tr 7 Document No. 3E7 <br /> WASTE MANIFEST of <br /> 3.Generator's Name and Mailing Address <br /> L.& n,4•Umbi $'tokA <br /> B E.1111th Tiihtmt <br /> Tr i GA 45376 <br /> 4.Generator's Phone( 2W)-'11`4'.44709 <br /> 5.Transporter 1 Company Name6. US EPA ID Number A.State Transporter's ID <br /> Adw96i. si44Yi1# IYht5#33hit.#4TMq�t '='"'1 B.Transporter I Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporters ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Nameq and Site Address r 10. US EPA ID Number E.State Facility's ID y <br /> AA2226.�5 Rt f # id F.Facility's Phone <br /> �.+ q <br /> �4 PJ.53,4 r' <br /> 11.WASTE DESCRIPTION Containers 13. 14. <br /> Total Unit <br /> No, Type Quantity Wt,/Vol. <br /> UQUW <br /> r f_ <br /> G b. <br /> E <br /> N <br /> E <br /> R c- <br /> A <br /> T <br /> O <br /> R d. <br /> LU <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> t!1 <br /> Q <br /> 15.Special Handling Instructions and Additional Information <br /> N <br /> Q <br /> S <br /> Z <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify thatthe 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 /> 'w9 <br /> Date <br /> Printedrryped Name Signature -Month Day Year <br /> E ^7 <br /> T 17, Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> N 'Pnnted/Typed Name Signalure �r r Month w Day Year <br /> P .. <br /> O 18. Transporter 2 Acknowledgement of Receipt of Materials Date <br /> R <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space <br /> A <br /> C. <br /> L20.Facility Owner or Operator:Certification of receipt of the waste materials covered by this manifest,except as noted in ilem 19. <br /> ' Date <br /> T PrintedrTyped Name Signature Month Day Year <br /> Y <br /> CF14 ©2002 LABWL AsTERO (800)621-5808 www.labelmaster.com nR '$ AMEN = <br />