Laserfiche WebLink
NG . .=HAZARDOUS WASTE MANii - EST <br /> Please print or type (Form designed for use on elHe (12 pitch) typewriter) <br /> NONHAZARDOUS 1 . Generators US EPA ID No. Manifest 2. Page 1 <br /> WASTE MANIFEST ` ' D°`m°°"` " of <br /> 3 Generators Name and Mailing Address <br /> 6JG f h <br /> - <br /> $ `fiansportet,lComparryName - 6.� US EPA ID Number ' A State Transporters ID - <br /> Mtib- DTra hn _ Y " kI - <br /> j ]. Transporter 2 Company Name - 8. US EPA ID Number - -- - - <br /> G. State TransportiosID <br /> D. Transpoder2 Phone <br /> 9. Designated Facility Name and Site Address 10, US EPA ID Number ;<E;$ha si F2c(7lty's ID <br /> l U C A f F Fact tytis Phan <br /> 11 . WASTE DESCRIPTION - 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity WrNol. <br /> a. <br /> w IF I.; nft- �_ n.._- <br /> Cl Q4 <br /> G le <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> W R <br /> H � <br /> G. Additional Descriptions for Materials Li(ted Above H. Handling Codes for Wastes Lisletl Above <br /> C>� L <br /> a <br /> Cr ( Qt> <br /> Q15. Special Handling Instructions and Additional Information <br /> Z <br /> 0 <br /> Z <br /> 16. GENERATOR'S CERTIFICATION: I hereby codify 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 to federal hazardous waste regulations. <br /> Data <br /> Pante irtyped Name Signature Month Day Year <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials LDate <br /> R <br /> A Prinled/ryped Name ` Signature Month Day Year <br /> S IIV5fIT byc <br /> p 18. Transporter 2 Acknowledgement of Receipt of Materials. Date <br /> R <br /> T Pnnted/ryped Name Signature <br /> Month Day Year <br /> F 19. Discrepancy Indication Space <br /> A <br /> 20. Facility Owner or Operator, Certification of receipt of the waste materials covered by this manifest except as noted in item 19- - <br /> ZC/JT "T-v'C, f Date <br /> TPrinted/Typed Signalu / _ Month Da <br /> Y lL <br /> Yf� e� j/f . i fir <br /> F-14 02002 LABELINASTER® (800) 621-5808 www.labelmm asler.co7/� <br /> Mail Vank Rev. 3r95 <br /> AROVINK <br />