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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1.Generator's US EPA ID No Mani Document 2.P 1 <br /> Manifest � . <br /> K i4 , of <br /> WASTE MANIFEST <br /> 3.Generator's Name and Mailing Address <br /> ��n. ,:'•a �.1` '� H`#�.�� 'g *�'' �3m �'+ �7 �,.'�Tfi �.3� �'" -'Y:,... a:.� e'`t.:€*� "::i&�,-� a., <br /> 4.Generator's Phone _f <br /> 5. spQrter 1 Comparl Name 6. US EPA ID Number A.State Transporter's ID <br /> B.Transporter.1 Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> i/V f, � .41N F.Facility's Phone <br /> 3. :.,- ?.,p 5,. ,Kc J''; "t� '� 'S �':. r,£�' `y Ex..',£ :-5`> _`:'3 •t. <br /> �` �'1Y.,is `:r y,t. / t < t,,: ?' r ',.z• ..0 aP'_.`'d k w i'°s'•..x,•:ir!. <br /> 11.WASTE DESCRIPTION 12. Containers 13. 1� <br /> Total Unit <br /> No. Type Quantity Wt.Nol. <br /> . P4 4? M.7'?.4�5.9,.�..a�.£..%� &ff.,4S, a R;1 u.k 4�;.;;k� y Y' .is.„L. 2r�, }.a.._ a;,. • <br /> l+' <br /> IL 7` <br /> G b <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T <br /> R d. <br /> G..Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> Cn <br /> 0 <br /> YIN 1011_lt <br /> e � � r�•& � .�' ?moi' <br /> Q <br /> N 15.Special Handling Instructions and Additional Information <br /> x��Y}} yr �� <br /> ^S �� �L't �. <br /> I <br /> 41 <br /> jail <br /> fk <br /> x G : <br /> Aff <br /> Aff Am���AV AFAW A� AFW <br /> AW AWAW AW Aff <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately escnbed and are i 'it respect <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardwaste regulation r <br /> p p M,. <br /> ^ Date <br /> Yea <br /> yped Name Signa reg Month D Y r <br /> /V .:� }_keg mss", <br /> ��� a. I 4. ...,�•''"N'"' as"�, ?a ? <br /> sh va•:''. <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R Signature Month Day Year <br /> A Printed/Typed Name <br /> , <br /> PDate <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Name Signature Month Day Year <br /> T <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 of the waste materials covered by this manifest,except as noted in item 19. <br /> L Date <br /> ' <br /> T Printed/Typed Name Signature Month Day Year <br /> _ <br /> Y <br /> CF14 O 2002 (ABELMASTUO (800)621-5808.www.labelmaster.com PRfNrEo4GSOYB ON SOYBELED AN <br /> PER pw;MTEowTH <br /> USING SOYBEAN fNK <br />