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NON-HAZARDOUS 1. Generoto.'s VS EPA ID No. DoNm*M No 2. Page 1 <br /> WASTE MANIFEST of <br /> 3. Generator's Name and Mo' Addro _. <br /> r-1DG f �/=/,9/� �7• �'%9,�✓Tf G'i9 l'%fs'' <br /> 1.3 <br /> A. Generator's Phone( <br /> f y Name <br /> D Numberc'.*.•�-' <br /> S. T onsporter 1 Company 6. <br /> _ FA <br /> r <br /> io <br /> 7-:Transporter 2 Company Named <br /> 8. US EPA ID Number <br /> 9yDesig t ata', Name Smote ddress )0 US EPA ID Number N: A. .Transporterrs Phone <br /> _ Jrty' . .t t n f r vtv to c Z^titi <br /> P ^�"� nspor ters'Phone <br /> r <br /> Facility's Phoney <br /> - <br /> }Y7 !�^' - •f ..a y a...t �t,:qt+ �. y,.yr i t r r �+ .ro?'J'}t.'3t `�.. v eyt. uwa�• <br /> ff <br /> a <br /> / / J �l '91 +t:.. 1 L—..." uy._.1 ._. 4rM •..2KYW <br /> ' - /, !, - 12. Container :13. 14. <br /> 11:-Waste Shipping Name and Description Total Unit <br /> No. . Type Quantity Wt Vol <br /> 77 <br /> pop <br /> G b. - .. <br /> E - <br /> N <br /> E <br /> A c - <br /> T �+ t r s 3 a { w x a +3�3 s a n t 'c r r a rrLu <br /> O P;4 LiV ►. F } <br /> t .. .. ,.,., - J -.•,i.Y�hr.-'r�+y�� 1i.4. t G t { t4 it: ,+: <br /> ., y+ .s, x''t4`Ti5.,..4•e.xr-r- --r w r�w»*wr';s t a s^ I rat la v-, v�:ci"�.{�71 `�4,+�- '' „�+` '7hfe�rw�'rW7ig•. � �-, � �r <br /> •d T .' ""'a.:.,...-t�:r�q s ,,,vim .,d•.u'.�t i�—y 7i�s 'ar,�."�" '1'Afff!'Mr'N r.r•a� f t <br /> '+ � «:�_9S3s,}V.1i7�LY£'$•`st •rae vn+;'�..�^c.:':.i:oi1'..�..y-�xU�i.��.. ..-L... w,:+cnY� '°"apY'� nH. <br /> ia..a :mss - <br /> �scr ��r-><.^�` `rte'srvc.DEs'?:1,.st, d`..#^in -�'t�;""rrr ...•."'� '�r s. �?'kc z,+,�'M�-c. � --r.'� •. <br /> D.,;Addrtronal�Deusiptions for•Materials Listed Above _ _ _ ��+ •-�t--• ' �'.�, E�Handling Codes for Wastes Usted Above <br /> � 1. � fir. e'R. � •tfr'1��'•': _ i. .�,M <br /> 15.-:Special Handling'Instructions and Additional-Information <br /> Kin. ti _ <br /> A s,.r' <br /> yf ��ct� -r'r. —'-�,.ti.Yz •�• � .._ o h:t .,ri+-.:. '�•c•-3�� Y ". 'z ... <br /> 16.GENERATOR'S={ERTIRCATION: I certify the motwiah desmbed oboes on Nus morifest ore' wbiod to federal requlot�ons 4w rrportirq proper disposal of Hazardous Woge, <br /> •Pri ed/T Nom y r.c. < < Signafuro Month Day Yr. <br /> J z ' <br /> T 17.-Transporter 1-Acknowledgement of Receipt of Moteriah <br /> A Pn d/Typed Nacos �• Signator M th / <br /> P <br /> O 18.Transporter Acknowledgement of Receipt Materials <br /> R Si nature Month Day year <br /> T Printed/Typed Nome g <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> hem 19. <br /> L 20.Facility Owner or Operotor.Certification of receipt of waste materials covered by this manifest except as noted in <br /> I <br /> T <br /> Y Signature Month Day year <br /> ' Printed/Typed Name g <br /> _ GENERATOR'S COPY <br /> �, 4 <br />