Laserfiche WebLink
NON-HAZARDOUS I Generators US EPA ID No Manifest 2 Page 1 <br /> WASTE MANIFEST Document No of <br /> Generators Nome and Mailing Address <br /> 4 Generators Phone <br /> 5 Transporter I Company Name / 6 US EPA ID Number <br /> ire , l , r' �C , A 11 101t t / ,- <br /> 7 <br /> .-7 Transporter 2 Company Name 8 US EPA ID Number <br /> i <br /> 9 Designated Facility Name and Site Address t0 US EPA ID Number A Transporter s Phone ) <br /> ( f�. k I f r k ,x,51 - Z«<G{A J'1 r.s r r• ,`,}, 8 Tronsporter's Phone <br /> t 11 �► e�rt 1� tL}(, -t J C Facility's Phone � <br /> fir T c 'y H rr <br /> T1G— -7 t, ar 4 01 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 i <br /> Total Unit <br /> No Type Quantity Wt Yol l <br /> a A, '/il 1AFMON <br /> G b <br /> E <br /> N i <br /> E f <br /> R <br /> A c <br /> T <br /> O <br /> R i <br /> d I <br /> D Additional Descriptions for MotereaIs Listed Above E Handling Codes for Wastes Listed Above I <br /> S <br /> 15 Special Handling Instrueteons and Additeonai Information } <br /> •� ^ r �" ( �!` kI,ve )f71 r- Tf/ <br /> � I <br /> i I <br /> II <br /> l <br /> 16 GENERATOR 5 CERTfF1CATION I Ler"fy rhe matenals deunbed above on this manifest are no wblea to federal re ns for repornnarprop ` pawl of Hazardous watts <br /> Printed/Typed Name i+y is f it t lire,i14signCtur Month Day Yeor <br /> do <br /> e <br /> T 17 Transport r I Acknowledgement of Receipt of Materia 1 <br /> APrinted/Typed Name Signature Month Day Year jI <br /> S <br /> p18 Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> T <br /> I <br /> Printed/Typed Name Signature Month Day Year <br /> GENERATOR'S COPY mmlili" <br />