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NON-HAZARDOUS WASTE MANIFEST - <br /> Please print or type (Form designed for use oDOUSn elite(12 pitch)typewriter) <br /> - <br /> 1.Generator's US EPA ID No. Manifest 2.Page 1 <br /> NOW"KAZA � .� � � � � Document No. � of <br /> WASTE MANIFEST � <br /> 10 <br /> 3.Generator's Name and Mailing Address <br /> . ACI -AS , PKLE 'r� M,- TRIACY SERVICE MY <br /> 502 R. GRANT LJKR <br /> TRACtY C 13845 <br /> � # <br /> 4.Generator's Phone( 925_5 <br /> 5 Tran rt 1 ompany 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 /> KIZEMONT WTUR <br /> ��� MSG �� F.Facility's Phone <br /> low UVEWRE 1, <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt.Nol. <br /> a. "Xis S01 14),� <br /> RGU <br /> AI J) WriVAIAls ONON IM-ARM <br /> D 00 1 8 Y <br /> to b. <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T � , <br /> O . <br /> R d. <br /> Lu <br /> Cn <br /> G.Additional Descriptions for Materials ListedAbove H.Handling Codes for Wastes Listed Above <br /> Ila 0: 31;,(M, - MON' HAZAXI`;' A_ lM 11b <br /> �..� <br /> 0 a <br /> 1d, <br /> cc 1*"3: U0,39 1po'lQ <br /> e <br /> 15.Special Handling Instructions and Additional Information <br /> 24 HOUTZ 877-577-26692109815 X <br /> <*N $ w <br /> a <br /> AV AV AW Aff AW AW M AW AW AW <br /> A;WV#rf 74f 1001"r <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately describe�h.and are in all respects�� <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazarcious waste regul ns. <br /> r <br /> Ad <br /> �. Date <br /> ped Name Signatur d Month D Year <br /> ,e_,_V,r60t <br /> 17.Transporter 1 Acknowledgement.of Receipt of Materials Date <br /> RAl <br /> Si nature `a Month Day Year <br /> A Print /Typed Name g <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials Date <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 /> 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 /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> ©2002 LABELASM0 (800)621-5808.www.lblt <br /> aemaser.com ��HrE�owREcrc�EOQ�r�R <br /> Mr .,�EOWx <br /> C F 14 USING sone l�soar INK <br />