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L. Generator's US EPA 10 No. Manifest 2. Page 1 <br /> NON-HAZARDOUS D°CUment No. of ti <br /> i� WASTE MANIFEST <br /> 3. Generator's Name and Mailing Address <br /> 4-Geneiaior`s Phone:( <br /> 5. Transporter 1 Company Name 6. US EPA ID Number A. Transporter',Phone <br /> r FTCYCL T.r..— c t. _.r. t: i. i� i3 ;l i. ? - I _y Jf,% <br /> 7.. Transporter 2 Company Name 8. US EPA ID Number B. Transporter's Phone <br /> 1 '.�'_ Rc t. z.'s<r sv rt'g'. a 1 :sycLi <br /> 9. Designated Facility Name and Site Address 10. - US EPA ID Number C. Facility's Phone <br /> i3.r, <br /> i.d°CtS. r i, t' A d <br /> 12. Containers 13., 14. <br /> 11. Waste Shipping Name and Description - Total Unit <br /> No. Type Quanti Wt/Val <br /> b. <br /> E <br /> R <br /> A c. <br /> T <br /> D. Additional Descriptions for Materials Listed Above- E. Handling Codes for Wastes Listed Above <br /> 1-19")C()i T s� <br /> 15. Special Handling Instructions and Additional Information - <br /> Wear- $pi7s,tsf T'1:14.'s, p"6r EL'T i' '— ,r a.ti t,Y l.7i`>'.; ' <br /> /4 :9l".13Y' <br /> G' 76.GENERATOR'S CERTIFICATION -cenity the materials descdbec'A ve a`n the maRfest ora nor sub'ett to fe'deTcl re ulmononsTor re vn - ds -sal of FP:v*0_ I Ins. <br /> I 9 Pe` g proper pa <br /> Prmteld/Typed Name ._ Signature ✓ Ma h a <br /> Dy <br /> nt Y.., <br /> 1 T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Name Signature ,. f / Month Day Yeor <br /> IN <br /> S 'r`� "f" (�'�\- ..Gl <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> t Printed/Typed Name Signature - Month Day Year <br /> s. E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C. <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 Signature Month Day Year <br /> Printed/Typed Nome 9 <br /> f <br /> GENFRATOR'S.COPY <br />