Laserfiche WebLink
' I <br /> NON-HAZARDOUS 1 Generators U5 EPA ID No Manifest 2 Page 1 <br /> Ail WASTE MANIFEST pocunt,J;la of <br /> 3 Generator's Name and Mailing Address �'�I�Cv f ��j Id <br /> �,a • C.4 . 0\4 3-Z Zo ,40 j -t <br /> 4 Generator's Phone c S 1 D) Ca �,� - $l;o o <br /> 5 T Drier 1 Cgmpony Na�r�u C US EPA ID Number <br /> 14 <br /> A. <br /> 7 Transporter 2 Company Name $ US EPA ID Number <br /> Itfacility Name and Site Address 10 US EPA ID Number A Transporters Phone 0, <br /> �'C�>� Q! LB Transporter's Phone <br /> ,( �L., S�.aQ� —T �� C aabty'sPhone <br /> 4 O - 11 —�� Cwt �ObC A-0oA- '��070 I 14) 3� -cam! <br /> l Waste Shipping Name and Descri tion 12 Containers of 14 <br /> pp g p Total Unit <br />' No Type Quantity Wt Vol <br /> a <br />' 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 />' 16 GENERATOR'S CERTIFICATION I certify the materials descnbed above on thn manifest are not subject to federal regulations for reporhng proper disposal of Hazardous Waste <br /> Month Day Year <br /> Si n ire <br /> Printed/Typed Name 9 � <br /> Et-FR-G Sp roe- Qi11.�r i 0 <br />' T 17 Transporter I Acknowledgement of Receipt of Materials <br /> R <br /> anted/Typed Name jS,g,,o!VkLP <br /> I on+ji Day Year <br /> " ie a �LA Fog. 9.%0AV <br /> 0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Nome 9 <br /> R Printed T Signature Month Day Year <br /> E <br /> R <br />' 19 Discrepancy Indication Space <br /> F <br /> A <br /> I <br /> L 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> 1 <br /> T <br /> Y <br /> Printed/Typed ed Name Signature Month Day Year <br /> Sin G t) 61d 99 <br /> 1 <br /> TRANSPORTER #1 i <br />