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NON-HAZARDOUS 1, Generator's US A ID No. Manifest Doc.No. 2. Page <br /> WASTE MANIFEST Pq or <br /> 3. erator's Name and Mailing A dres �, l <br /> o <br /> CL <br /> t 7 �l1 <br /> 4. Geder o' P a ( fro) �v7-Cdd <br /> 5. Tran pone^=om arrf 6. USEP D Number T sport Ph <br /> J�>�•� ---� . . one <br /> 7. Transporter 2 Company Name a. US EPA ID Number B. Transp s Phone <br /> I <br /> 9. Designated Facifity Name anj*' Ad ress 10. US EPA ID Number C. Facility's Phone <br /> 11.Waste Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> may, ) +� No. Type Quantity Wt/V01a.Aja c�3 � <br /> j rUi3'1 :5t c5.u m d <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> A c. <br /> T <br /> O <br /> R <br /> d, <br /> i <br /> dditionW Descriptions for Materials Listed Above ++ II E. Handling Codes for Wastes Listed Above <br /> S�r 1 �.►..5 �j� Cry.` 1`'�� <br /> 15. Special Handling Instructions and Additional Information <br /> 3- <br /> :7�z <br /> 16. GENERATOR'S CERTIFICATION: I cert! erials described above on this maniiest are not subject to tedeVal regulations for reporting proper disposal of Hazardous Waste. <br /> r yped Name n Sure 110r Day Year <br /> T 17,Transporter llAcknowledgementof Receipt of Materials <br /> w R <br /> t' N P' ed/Typed Name L Sign Month �jDo �Yeya� ; <br /> P T y <br /> R1 B.Transporter 2 Acknowledgement of ceipt of Materials <br /> s R PrintedlTyped Name S'sgnature Month Day Year <br /> 19. Discrepancy Indication Space <br /> A <br /> C <br /> t�Facilityneror Operator:Certification of receipt of waste materials covered by this manifest except as noted in Item 19. h�< <br /> y f <br /> Printed/Typed Name Signature Month Day Year <br /> �F <br /> Printed by J.J.KELLER 8 ASSOCIATES.INC. <br /> Neenah,wl 54.957-0M 12-BLS-05 Rev. 12/98 <br />'. 5 �..,.�...-_.� ... •.� ���••_=- <br /> ATOR <br /> ORIGINAL - RETURN TO GENER <br />