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NONQAZARDOUS WASTE MANIFti,6T <br /> PaasePdnt or ty QPorm tlesignetl for use on elite{121.Generator's <br /> r) <br /> i' 1.Generators US EPA 1D No. Document <br /> el 2.Page t <br /> NOIU�MAZARDOUS DocumentNo- <br /> WASTE MANIFEST <br /> 3.Generators Name and Mailing Address j-ili-o <br /> a r <br /> A 9.Generator s Phone( ) <br /> 5.Transporter 1 Company Nartw_ r�C Q _} 6. US EPA ID Number A Sate Tmnsporter's ID <br /> cry 't B.Transporter t Phone <br /> 7.Transporter 2 Company Name 8, US EPA ID Number C.State Transporters M <br /> ;11 - D_Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10, US EPA ID Number E.Sate Facility's ID <br /> F.Facility's Phone <br /> 12. Containers 13. t4' <br /> it.WASTE DESCRIPTION Total Unit <br /> No. Type Quantity WtNol <br /> lbebvI5 ( �es-s��`� torJ <br /> G b <br /> E <br /> N <br /> E <br /> R e. <br /> A <br /> T <br /> 0 <br /> til R tl <br /> N <br /> Q G.Additional Des mptiot5 for Materials Listed Above _ H.Handling Codes for Wastes Listed Above <br /> fIJW' .` Irt~j <br /> OY ' <br /> G <br /> Q <br /> N 15.Special Hand1mg Instructions and Additional Information <br /> Q <br /> , <br /> 0 ._ <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby cedity that the contents of this shipment are fully and accurately described and are In all respects <br /> in proper Wnd8ion for transport.The materials described on this mamilest are not subject to fe <br /> deral hazardous waste regulations. <br /> Date <br /> Pdntedayped Name. Signature Month Day Year <br /> T 17.Transporler'1 Acknowledgement of Receipt of Materials Date <br /> R <br /> A Pdnted/Typed Name Signature Month Day Year <br /> IN It n <br /> p18.Tmnsponer 2 AdmovAedgeme !of Rec+t of Materials Date <br /> TPrintedRyped Name Signature - Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space , <br /> F <br /> A <br /> - I 20.Fadlfty Owner orOperator,Codification of reoupt of the waste materials covered by this manifest,except as noted In item 19. <br /> L Date <br /> ,j Pdnted/fyPed Name Signature Montrt DaY Ypar <br /> v lutiiti> i.~riH„— � fc �i I <br /> F-1402002 LABELMASTER® f800)621.5808 feweiJabeenestercom - Rev.395 <br />