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06/02/2016 10;37 (FAX) P,053/065 <br />r <br />NON-HAZARD0U8 1 Qenorafor ID Ndarrher 2. Page 1 of 3. Emargarwy Reamum Phone 4 WNW 1}ncld Nrr bar <br />WASTE MANIFEST:�',� <br />3 l;ar ;w�,;v;a�IJ'Li, <br />1 <br />`1U 7 � � l � % � r IQ m <br />S. Gonarwe Namend Maling Add r0ay, <br />v �+ '� ck; �lCl,�� C. roan <br />Genararor'e SW A" (9 dMte than maikp <br />16 - ( <br />a <br />I 1f zee._ <br />e -n % c <br />'7e) <br />�/� <br />�y I �- CJS L-�`r <br />erator's Phone: ! - _ l ; I _ - { <br />�L <br />l / <br />8. T rier Company N me <br />U.$. EPA ID Number <br />l Y <br />N11 oi�Si,e�L�w' <br />7. 7 er 216 ams <br />U.9, EPA ID Number <br />8. Desi diad Fadity Name and Ste Address <br />U,3. EPA ID Norman <br />C PD <br />d �t.� <br />V t� ^ CAW <br />FACM 'a Phona' (70 37-P2,Mrv%!0 <br />0. Waste Shipping Name and D9apIp1 m <br />10. Ca, nladnem 11. Todal 1200 <br />No. Type Quwky MNot <br />y rj r^ I`-l�: c. - e, <br />L <br />2. <br />ra <br />3. <br />4. <br />13, Spodal Handling Inabucdons and Addillonal Horn Uon i�E�T p�Lrr� <br />Ht=F�TH 1:�• , <br />14, OENERATOR'SKffEROR'S CERT64CATION: I hereby dedare that the 0antenia of Itis conslpnrnertt are Iulty and acouraley daeratbed above by the proper shipping name, and are dasslfled, packaged, <br />markad and Wmisdipterarded, and are In atl raipwts M proper oondltlon for imnapart a000rdng to applicable inlemationai national gove+mreMel <br />Gwterelor Ofleroes Pdniadrrypod Name dregulndons. <br />Sipnam� D� <br />. ,�. <br />Ij <br />16. IMemaliaral 9h1prWis ❑ Import 10 U.S. ❑ <br />Export from U.9. Pon of er,iry/exrc <br />Yrs oder Skinaturs, flor.axports 0 y, D* leavin U.S.: <br />18. TranapoAsr AoMwrvladgment of Receipt of Materials <br />Tra War I 1511drt yped N a f Signature <br />r/{j � ldcoh Day Y <br />p, <br />Trenap f l pad e 4 Slgrretun Month gayf P au <br />17. DWrepancy <br />178. Ditarepency IrrdiceUat Space ❑ �I1--'�tt QuantNy ❑ Type 13 Raklw ❑ Panld Ro*tlon LJ Full Rele0on <br />urndur P.I.— M—h— <br />Generator} <br />Facitf a Phone: <br />17C. SlgnaNre of Allemate Facility (or Generator) Month pay year <br />18. Deaignefed Faft9wner or Operator. Cenll Akn o1 <br />rrlpti)dfF�ped NarM <br />ALS -r S 11 W to. oma► <br />by the mar&ol except.m noted In Item 178 <br />Month Day Ya r <br />