Laserfiche WebLink
NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON <br /> ® 1.Generator's US EPA ID No. Manifest U 2.Page 1 HAZARDOUS <br /> Document No. <br /> WASTE MANIFEST of <br /> 3.Generator's Name and Mailing Address <br /> kv <br /> K.3 <br /> 1_1 ?f IN,Vk <br /> 37 <br /> 4.Generator's Phone(q j, <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's ID <br /> A� <br /> B.Transporter 1 Phone <br /> V <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 /> N T <br /> j, <br /> 4 kr` V -h-IJ F.Facility's PhqQq,,,,,i-` �kk,,!, <br /> A <br /> 9 <br /> 'V <br /> A <br /> _4 <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt.Nol. <br /> a. <br /> i--:J,A <br /> 4 y <br /> G b. <br /> E <br /> N <br /> E <br /> R C. <br /> A <br /> T <br /> 0. <br /> ;d. <br /> UJ <br /> G Additional Descriptions for Materials Listed Above H.Handling Codes for,,Wastes Listed Above <br /> J� <br /> x, <br /> Cn <br /> ® ig--r? A <br /> 0_%_0(1161D 13, <br /> 15.Special Handling Instructions and Additional Information <br /> i 411`t <br /> A` <br /> A <br /> 0 <br /> Z <br /> Aff AW AV AAW AW AW AW AW AW AW AV AW AV AAW AW AM <br /> i. <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respectsP.;i <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Month Day yq;qf <br /> Signatu <br /> ri Fyped Name IT <br /> etv <br /> 2, <br /> T 17.Transportdr 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> A Printed/Typed Name Signature Month Day Year <br /> k: <br /> j <br /> 0, <br /> L <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 /> 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 <br /> Date <br /> E <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> CF1 4 ©2002 LAAE1AASTEJR*@ (800)621-5808 www.label master.corn JaX PRINTEDON RECYCLED PAPER <br /> USING SOYBEAN INK <br />