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'f <br /> 2. Poo 1 <br /> NON-HAZARDOUS <br /> mast <br /> Ma g <br /> 1• Ganarotors US EPA ID No. Document No. <br /> of <br /> WASTE MANIFEST <br /> 3. Generator's No a and Mailing Address <br /> 4. Generator's Phone <br /> 5.tTransporter 1 Comp-any Name 1 6. US EPA ID Number •` <br /> US EPA ID Number <br /> 7. Transporter 2 Company Nome 1•' 8. <br /> 9:`Designated Facility Name and Site Address 1.�+w rw•#, ^10 US EPA ID Number A`.Transporters Phone <br /> 'r <br /> t B. Transporter's Phone <br /> ` ✓;" 'V.� f� ^� i,�GG O l�.!JJ ,.. � 42." ` ,� �� C. Facility's Phone <br /> _•.'�.1n1(,.�.C�r�r� ; "��I i �jll.1���1��f " ��Iy `� <br /> 12. Containers 13. 14.; <br /> 11. Waste Shipping Name and Description Total Unit <br /> No. Type Quonti Wt Vol <br /> G b• <br /> E <br /> N <br /> E <br /> A c <br /> 7 <br /> R .z-.. r .. <br /> •'tLs+Y+ L.+ <br /> E. Handling Codes for Wastes Listed Above <br /> D. Additional Descriptions for Materials Listed Above T <br /> 7. <br /> 15. Special Handling Instructions and Additional Information <br /> .1 <br /> 16.GENERATOR'S CERTIFICATION: I certify the motoriols described obov,-c this morwfast an not wbjact to federal regulations for reporting proper disposal of Hoxordoos Wosts. <br /> P' tad/ ped Name Stg to Month Dor Yaor <br /> 1' ) IJ� <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Nome Signature Month Day Year <br /> S I N•` r. r it <br /> n <br /> P <br /> o 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Nome Sipnaturs Month Dor Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted in Item 19. <br /> 1 <br /> T <br /> Y Printed/Typed Name Signature Month Day Yeor <br /> GENERATOR'S COPY <br /> .t <br />