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NON-HAZARD.-OUSWASTE MANIFEST
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<br /> NON-HAZARDOUS1.Generator's US EPA ID.No Manifest 2.Page 1
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<br /> WASTEMANIFEST 10 of
<br /> 3.Generator's Name and Mailing Address 3•
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<br /> 4.Generator's Phone
<br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's ID
<br /> � .y '" B.'Transporter 1 Phone
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<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
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<br /> F.Facility's P
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<br /> 11.WASTE DESCRIPTION 12. Containers 13. 14.
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<br /> Total Unit
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<br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above
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<br /> 15.Special Handling Instructions and Additional Information
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<br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately cLescriop.d and are in all respects
<br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardo wast regulafiGU.
<br /> Date
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<br /> 'Ent wed Name ignaz nth r,
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<br /> 40
<br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date
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<br /> A Printed/Typed Name Signature ,t Month Day Year
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<br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials Date
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<br /> T Printed/Typed Name Signa'ure Month Day Year
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<br /> 19.Discrepancy Indication Space
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<br /> 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19.
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<br /> Date
<br /> T Printed/Typed Name Signature Month Day Year
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<br /> CF14 ©2002• LABEAASTER® (800)621--5808.www.labelmaster.com PRINTED ON RECYCLED PAPER pp1MTE0 WrtN
<br /> USING SOYBEAN INK r�j SOY IEVK
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