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NON HAZARDOUS I Generators US EPA 10 No I Manifest 2 Page I <br /> i WASTE MANIFEST Document No <br /> 3 Generators Name andMailing Address a <br /> I�fG�IVE� Ft �d�/� liK� S Srcci� �cn'!i c 1. R►!H r5 i A ,cu /)y till I <br /> YL rf Ar c l r'Y - YIl4 5 _N�lr/y r , �� c.vtCvv iC <br /> 4 Generators Phone I <br /> 5 Transporter 1 Company Name 6 US EPA ID Number <br /> 7 `Transporter 2 Company Name B US EPA ID Number <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number A Transporter s Phone <br /> ��`- 1 ilk/; /�' /T�![ /�t E ►/fid �� rr Lo/! 8 Transporters Phone <br /> JC ^ jjjichri. /J`/ a t I C Facility s Phone <br /> 11 Waste Shipping Name and Description i 12 Containers 13 14 <br /> Total Unit <br /> No Type Quantity wtj Vol <br /> is ':A <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> 0 <br /> R <br /> d <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> ;.t <br /> 15 Special Handling Instructions and Additional Information <br /> - � ' •�7 i��-i /./r/t! � it/ ��� �. . — /- i.-��/�' ^F � �L. ~� //�.! <br /> I i <br /> 16 GENERATOR'S CERTIFICATION I cenity the materials descnbed above on this manifest P16,11ot stbiect to ederol reg ions tar reporting pro er disposal of Hazardous Wash <br /> urs r i:.�i <br /> armtedjyped Name r.v s 9, Signal Month Day Year <br /> i 1! .f ire_ _ /� / ♦ '.n �.+� s 1 <br /> T 17 Transporter I Acknowledgement of Receipt of Materials <br /> R <br /> A Orinted/Typed ame s I Signature/ / n Month Day Year <br /> IN S �r�l ,rr� LJ r'1 f��+r'L / (w <br /> 0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day year <br /> E <br /> R i <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> 20 Fa ty wn r r O e or �C r honiadfft <br /> sre tori I c vrr I b'py th s anile aiiC t�s nate m <br /> I l,l� l {l <br /> Y Pcrnt d/�y p, �FaFl�e � Si�4rr/ � � oath DaY ew <br /> ORIGINAL-RETURN TO GENERATdIt <br />