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54M <br /> NON-HAZARDOUSIL <br /> Generators US EPA ID No Manifest 2 Ppge i STY;tIo►� '�13r1• <br /> WASTE MANIFEST L Q Q c] 043 4 t �°`utrlpnt No of Qy/skTs7sp lL <br /> 3 Generators Name and Marling Address O 1)I K O49IV��+ <br /> 0 64* 15_?46 VxtA�n Vxf,C Ak q 4.,S•'S-7 V <br /> 3T2EeT AVDczsj.- 4 S(di E1.!•re124pf24St 5MEE'r R4h <br /> 4 Generator's Phone( y d f GS <br /> 5 Transporter i Company Name b US EPA ID Number <br /> rN <br /> Q1 G S1o#-i C A.V� a a 1 4 io X 3 9 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number <br /> 9 Designs d Facility Name and Site Address 10 US EPA ID Number A Transporters Phone(41 O r <br /> A 5Q 8 Transporters Phone <br /> 4 � Srts�a po�T Bc.JA- <br /> C Faalrtl/s Phone <br /> [�►- fl G r 6A. o ? 401 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14. <br /> Total Unit <br /> No Type Quan Wt VOI <br /> -rptlto <br /> J!"0 o a 4 <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> 0 <br /> R <br /> d <br /> D Additional Descriptions for Materials listed Above E Handling Codes for Wastes Listed Above <br /> 15 Special Handling Instructions and Additional Information <br /> 15 GENERATORS CERTIFICATION I certify the materials described above on this manifest are not to federal regulations for reporting proper disposal of Ha¢ardom Waste <br /> LS <br /> Printed/Typed Nome Signature 4 ! th Day Year <br /> RT 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> APrinT I Signator <br /> N <br /> 5V461 <br /> P *q. dy!(41 <br /> R 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> E Printed/Typed Name r1g.. <br /> ture Month fray Year <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> 20 Fanlity Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> Y <br /> Printed/Typed Name Signature Month Day Year <br /> TRANSPORTER#2 <br />