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./ Soo <br /> NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(42 pitch)typewriter) <br /> NON-HAZARDOUS <br /> Generator's US EPA 10 No, Manifest 2.Page+ <br /> WASTE MANIFEST DocumentNoAd i,- L of <br /> 3.Generator's Name and Mailing Address ,J\I, }C _ J s" <br /> {-r..-0 7 aL'(�(/t� <br /> G•^�C <br /> d.Generator's Phone <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's ID - <br /> 1 T ��/"• B.Transporter+Phon `%d <br /> 7.Transporter 2 Company Name 0. US EPA ID Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facilitys 10 <br /> +1"6,> E !'� j�G T F.Faciutys Phone <br /> Lz, 51r� t'f�• Cr G. "cF4 {5c�4��I� <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wl.ivol. <br /> a. <br /> G a- <br /> E <br /> N <br /> R <br /> A <br /> T <br /> O <br /> R <br /> W d. <br /> I— <br /> N <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> O <br /> D <br /> a y (•e J <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 10 federal hazardous waste regulations. <br /> Data <br /> Printed/Typed Name Signature Month Day Y0a1 <br /> T 17.Transporter 1 Acknowledgement of Recoipt el Materials Date <br /> R <br /> A Printed?yped Name Signature Month Day Year <br /> N j,v /,Uc <br /> 0 t 8.Transporter 2 Acknowledgement of Receipt of Marerlals Data <br /> R Printed/Tped Name <br /> T ySignature Monfh Day Your <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20.Facility Owner or Operator;Cerlification of receipt of the waste malerlals covered by this manifest,except as noted in item 19. <br /> 1•' -2--"27 Dalo <br /> T Pdnladlryped Name J Signature i / Monne Day Year <br /> e <br /> F-IS tr32002 LABELMASTER®(800)621-5808 vnvw.labelmasWr.com PRINTED eN nECYbdbPMER Rev.3735 <br /> ,N�ie�i+�rw <br /> USING SOYBEAN fa( r _ISDNl NIC <br />