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1! it <br /> 1.Generator ID Number <br /> NON-HAZARDOUS Page 1 d 3.Emergency Response Phone a.Waste Tracking Numher l— [[ ((�� a <br /> WASTE MANIFEST J Ir��G p J <br /> 5. enerators Name and Mating Address Genemm s Site Address in cmurem Man melttlg address) <br /> n,.:'^r .. '; : . .. ^.., F"x'.,'�':1�.. .29J1 :',✓ N.:.:eh±'n, L... .. , t.a:*... Z„� <br /> Generators Phone <br /> &Transporler 1 Company Name U.S EPA ID Nut ber <br /> 7.Transponer 2 .y Name <br /> US,EPA IU Number <br /> S.Desipalod Fa*0 NenSilo Address U.S.FPA ID Number <br /> Fa*trs Phone' <br /> r <br /> ga. 9b,U.S.DOT Description(indut1mg Proper Shipping Name) lo.Conlailars tl.Tdal 12.Unit <br /> No. Type cantly Wt.Atl. <br /> 1. <br /> M TC W”.iN: r.. ;ivmi C t! <br /> w 2' <br /> i <br /> 3. <br /> I <br /> 4. <br /> 13.Wal HandfiN instructions aM Addliowd Inbrmotion <br /> r��'r 7:hW r:•r zxRr.��rfc.�. • (s�."y)4�-�:k� :-:�:,.1: 4212SWe„�� <br /> -Tv; nl.'t 911Ttr17 <br /> 11.GENERATOWS CERTIFICATION:I comity the materiels described drove on Ilk mangest are not subject to lederal regulallons for reaching Proper disposal of Haurdous Waste. <br /> Oene7b.,fm�0�lexT{SPyiplerlrtvcea Mame a .?9G'I t Signature l ," ��' MDay Year <br /> i.d �. <br /> J15.International Shipments ❑ ' <br /> r purl to U.S. ❑F_xpod from U.S. Purl d enUy/axil: � <br /> z Tranaporler Signature((or exports only): ,'Date leaving U.S.:. _ <br /> w 16.7rensporter Adw rarigement d Receipt of Materials f T , " ' �) TI i <br /> CTransporter 1 Pdnted/pyped Name` Signature �. Month Day yey <br /> a Transports 2 Pmltedrryped Name Signature Month Day War .: <br /> F <br /> 17.DWrepam;y „ <br /> 17a Disrrep my mdrcalion Space ❑DuaMity ❑Type ❑Residue ❑Pad'al Rejection ❑Full Rejeclgn <br /> Manlfem Reference Number: <br /> .x Z 170.Alternate Fadliy(or Generator) U.S.EPAIDNumber <br /> LL Fadi s Phone: <br /> UC Signal..of AlW.mata Fadli y(or Generalnr) Mudh Day Mar <br /> W <br /> Z <br /> c7 <br /> W <br /> 16.Desigutad rads y Omer or Operator:Certilicadnn of receip4ot mdedalscorned by Ure madfest except as noted in Item 17a ( F <br /> Pthodtyped Name t Signature M 7 Day tear <br /> 169•BLC•0 5 11977(Rev:9/09) ) TRANSPORTER#2 <br />