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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> 1.Generator's US EPA ID No. Manifest 2.Page 1 <br /> NON-HAZARDOUS '45:� V <br /> k :RA, Document N <br /> Ni <br /> Cf 1�;, . .,�V Of <br /> 4, 10 <br /> Ace <br /> WASTE MANIFEST <br /> 3.Generator's Name and Mailing Address V,i,E <br /> 4.Generator's Phone <br /> 5.Transporter 1 Company 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 /> ID.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> F.Facility's Phone <br /> 3? <br /> 'A <br /> -t' h.A" <br /> A <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt.Nol., <br /> a <br /> G b. <br /> E <br /> N <br /> E <br /> R c- <br /> A <br /> -T <br /> 0. <br /> W d'. <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> 4.4 4w, <br /> x <br /> 0 <br /> 15.Special Handling Instructions and Additional Information <br /> 4 <br /> k� <br /> 0 <br /> AJffAAWAWAWAAWAWAWAffAWAWAWAVA1F <br /> AV <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify 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 hazard0 s wast,611",regulations.. <br /> Date <br /> Z' <br /> Print N a m e Signatu Month Day Year <br /> �J <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R Signature Month Day Year <br /> A Printed/Typed Name <br /> N <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 /> 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 F Date <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> CF1 4 2002 LABEAASTER R (800)621-5808 www.labelmaster.com PRINTED ON RECYCLED PAPER <br /> USING SOYBEAN INK <br />