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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> 1.G.-ne ato' U.►SEP_ID o.. Manifest 2.Page 1 <br /> NON-HAZAR .. �� Document No. .. <br /> 1026# of <br /> WASTE MANIFEST <br /> . (;tAM ' LINE ROAD <br /> 4.Generator's Phone( ,9,11141) <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's ID <br /> B.Transporter 1 Phone <br /> 7.TranspoAkh JJ6NWhjZM3 `- 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 /> 149 <br /> - 4 � �� : � � <br /> .:�, `� ,.� � ic�`�"- �� '.'„. F.Facility's Ph X,0/4 :.�.� <br /> IV , .. <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt.NoL <br /> HAV <br /> 0 0 1 8 <br /> G b. <br /> , E - <br /> N <br /> E. <br /> R c. <br /> A <br /> T _ <br /> O <br /> d. <br /> ul <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> .:`, <br /> : '. <br /> 15.Special Handling Instructions and Additional Information <br /> WXM, P .� <br /> z <br /> ® <br /> AW AW AW AW A9 <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurat described and are in all respects QIV M41111741r <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazadbus waste regula <br /> At 7 <br /> Date <br /> Si na e n: �`� onth Da <br /> Printed/Type g <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R* <br /> Arintet/-rrd Name Sign re <br /> �,on�th a Ye <br /> S <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 <br /> Date <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> CF14 ©2002 l^BELMASTER® (800)621-5808.www.labelmaster.com PRINTED <br /> USNGSOYBEAN IcA�R <br /> J. <br />