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r-w <br /> NON-HAZARDOU51 Generators US EPA ID Noy D cumentsNo r 2 Page 1 ` t <br /> WASTE MANIFEST � s� € of I <br /> 3 Ge erator's Name and Mailing Address <br /> S 1 a�}r ,,F1 i t S <br /> W1tRE G S1'1?i 1 S. i tial 02004 --, - <br /> 4 Generator's Phone( JSk ) -01-6600 �I <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> 1�ILFEF k (_'Y(TTPJCx .AS, PW -?tits � � P 0 0 Q 1 �' ty (5)0)61"'0__11001 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Tronsporter's Phone ; <br /> F1 l tv Rei scl1lls� X01 s fcc - 1 I11C t P 9 18 2 1 4 4 4 1 `909)-0r3-4111 <br /> 9 Designated Facility Name and Site Address 10 US EPA I'D Number C+ Facility's Phone h <br /> i=tlte c Ric,cyrcIing, bEi5ic ° m {g0Q,1 4 2t- _,1012 <br /> 11,30 IV Pkmte %-�kanlu­ <br /> k1a I (o, ("x 1)2.116 IA 013 5 2 4 4 4 4 t <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> No Type Quantic Wt vol <br /> a N`�N PLAZ"AFTYO 7 S(;11 If) t <br /> E b r ,L'AT f ori 1 1d'f C f ie AS lr:. <br /> "e 9A. f <br /> R F <br /> A c <br /> T <br /> O <br /> RM <br /> d <br /> 1 _ <br /> 1 D Additional Descriptions for Mate�ri%f!.�steiyl Above E Handling Codes for Wastes Listed Above <br /> V vy� c <br /> 15 Special Handling Instructions and Additional Information <br /> SVc,11 t1pplopit<li: <br /> y T <br /> 13 <br /> Cl 1 4T�,T rti-1 1'1 T 1`4AP I A111- <br /> 34 lkC os" t 11aG'f t31 i f�.L;jiCliT`il' u ( "1 —21 1,0r ) �ff t(`�i1rJl4 t 1 i R <br /> RTLI SLA B. �, }<J1Q, <br /> J <br /> 16 GENERATOR'S CERTIFICATION I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> _ Printed/Typed Name Signature oPf ' yy' xear <br /> � `�` r^ 7�`/ I <br /> ',' 7 ,1 7 <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials Jr <br /> APrint d/Typed Nortje Signature y' <br /> N C _ � IA <br /> P <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials ' <br /> r T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space ` <br /> F <br /> r F T <br /> A <br /> C <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> rT <br /> Y Printed/TypedJuQm Signature Hlanth°"'Day� Year rte, <br /> �l <br /> GENERATORS S COPY <br /> u _ _ <br />