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NON-HAZARDOUS WASTE MANIFEST <br /> Ple as`print or type (Form designed for use on elite(12 pitch)typewriter) <br /> 1.Generators US EPA ID No. Manifest 2.Page 1 <br /> NON-HAZARDOUS Doca No.� of <br /> I <br /> WASTE MANIFEST �} <br /> 3.Generators Name and Mailing Address S G C'A -`A 0- <br /> 1 19 S FtEE. Bl"Irk-R RD Au'JA 1 ) o C-)e Eli <br /> 4.Generator's Phone( ) S I OCK I-SDN CTT <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Slate Transporters ID <br /> I mg- an11 IN l: B.Transporter Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number G State Transportels ID <br /> D.Transaction 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> ay <br /> rtgqrp�pypeyyfy-gy lq�ey�,}, F.Facility's Phone —v <br /> 11.WASTE DESCRIPTION 12. Containers 13, 14. <br /> Total Unit <br /> No, Type Quantity Wt VoL <br /> a. lel nnr- az ` I L <t -'EQ R IS ( D R M (_100 <br /> G t, <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> L <br /> R d. <br /> n <br /> G.Additional Descriptions for Materials Listed Above G. Handling Codes for Wastes Listed Above <br /> 3 <br /> D <br /> r <br /> 1 <br /> Z15.Special Handling Instructions and Additional Information <br /> Z <br /> D <br /> 7 <br /> AV AW M AV <br /> — — AV AV AV M AV AW AV — AV AW M <br /> — <br /> 16.GENERATORS CERTIFICATION:I hereby cenily that the contents of this shipment are IWIy and accurately described and are In all respects <br /> in proper condition lot transport.The materials descnbed on this manifest are not subject to ederal hazardous waste regulations. <br /> Date <br /> PnMerfType l Name Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Matenais _ Date <br /> R <br /> A PdMeNrypetl Name Signature y _ Month Day Year <br /> p18.Transporter 2 AcWwwledgemend of Receipt of Matenais J - (! Date <br /> TPrintecirryped Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20.Facility Owner or Operator,Certification of receipt M the waste materials covered by this manifest,except as noted in item 19. <br /> L <br /> Irate <br /> T Printedrryped Name signeiure !1 �A Monm Day Year <br /> Y MICHALL 1JN[7"eP > fes, 0 ALJ to If IT <br /> F-1402002 LASEAASTERO (000)621-5806 www.labelm"Incom nssax Rev.395 <br /> erwtsx <br />