Laserfiche WebLink
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 Document No t4 <br /> of <br /> WASTE MANIFEST <br /> 3.Generator's Name and Mailing Address <br /> Olt <br /> 4 <br /> P", <br /> 1..r.5.kie41 <br /> ? <br /> y=a; s <br /> 4.Generator's Phone _41,4."� R <br /> 5.T7s,pooer 1 Company N me 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 /> F4. . <br /> IJ <br /> Facility's Phone <br /> A A-3 <br /> "X <br /> tyi <br /> 12. Containers 13. 14. <br /> 11.WASTE DESCRIPTION Total Uhit <br /> No. Type Quantity Wt.N'ol. <br /> a. <br /> N <br /> K <br /> k <br /> M A 3 �4 3.,f� It <br /> G b. <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T <br /> 0— <br /> d. <br /> W <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> Z. .q,Ar,J A'. ..'4' <br /> 14 <br /> 0 <br /> cc <br /> 15.Special Handling Instructions and Additional Information <br /> I V <br /> "N <br /> Q <br /> 2 4 14!_00 <br /> 4, <br /> 0 <br /> A�AW A�AW AW AW AV <br /> AW AWAW AV AM AM AMMMM <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects LJ774 .77477777737,%-F, <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardaus waste reclulati s. <br /> Date <br /> e ame Signatu Month Day Year <br /> W <br /> e <br /> 11 <br /> T 17.Transporter.1 Acknowledgement of-Receipt of Materials Date <br /> R <br /> A Printed/Typed Name Signature Month Day Year <br /> 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> R. Printed/Typed Name 1. 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 /> JITIlk PRINTED ON RECYCLED PAPER <br /> CF 14 ©2002 LABEAASTEP,(D (800)621.5808.wwwlabelmastercom USING SOYBEAN INX <br />