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' NON-HAZARDOUS 1 Generators US EPA ID No Manifest 2 Page 1 �f�Tls <br /> WASTE MANIFEST CAL Q Q Z Q45 3A4 113_X(Vt Hoa <br /> Gfen1eratars Name andel Msa�I Address gvlK <br /> % Generators Phone <br /> (Sto <br /> 5 Transporter 1 Company Name 6A 1D OUS EQPA IDS (0 TC <br />' 7 Transporter 2 Company Name 8 US EPA ID Number /7 <br />' 9sgnaitedcaciliZ41 <br /> meSite Address 10 US EPA ID Number A Transporter's Phone Gj1 D 1 X13 <br /> .—��7 J5 �gyp,�ati.T F�E.rt1 D B Transporters Phone <br /> C Faalrt�s Phone <br /> C p� � f cA q �(o2 C A ID 0 4-3 1 to 0 "77 <br /> " O r G6 I <br /> j L4�5 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> No Type Quante Wt Vol <br /> >99_6CL Is 11-10 <br /> G b <br /> E <br />' E <br /> E <br /> R <br /> A c <br /> T <br />' O <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 /> 16 GENERATOR'S CERTIFICATION I certify the materials desenbed above on this manifest are not subted to federal regulations For reporting proper disposal of Hazardous Wane <br /> Printed/Typed Name Signature f} Month Day Y <br /> T 17 Transporter 1 Acknowledgement 4f fecerpt of Materials <br />' A Printed/Typedme Signa re Month Day Year <br /> S i G' rJm:, .S <br /> p 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> 1 E Printed/Typed Name Signature Month Day Year R <br /> 19 Discrepancy Indication Space <br />' F <br /> A <br /> C <br /> I <br /> L 20 Facility Owner or Operator Certification of receipt of woste matenals covered by this manifest except as noted in Item 19 <br /> 1 <br /> T <br /> Y <br /> Panted/Typed Name Signature Month Day Year <br /> TRANSPORTER #2 <br />