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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> c NON-HAZARDOUS 1.Generator's US EPA ID No. Manifest r2Page 1 <br /> WASTE MANIFEST'`z - o j <br /> 3 Generator's Name and Mailing Address <br /> 1"2•'�2„. �}• 'ens'`Y �J t�a u fs t90, <br /> 4 Generator's Phone( ) <br /> S.aTrf�anslTorter 1 Company Name <br /> 6. US EPA ID Number A.State Transporter's 1D <br /> 13.Transportgr Tq)314— <br /> 7.Transporter 2 Company Name 6 US EPA ID Number C State Transponer's ID <br /> D.Transporter 2 Phone <br /> 9 Designated Facility Name and Site Address 10. US EPA ID Number E.State Faaty's ID <br /> a✓ MI a <br /> "05 C MFORT F& F.Facility's Phone <br /> RW'di3 X CA CX571 1 (j"•. <br /> 11 WASTE DESCRIPTION 12. Containers 13 14. <br /> Total Unit <br /> No. Type Ouantfty WVVot. <br /> a. <br /> `� Nara N�z.�_tb�s D 21�c. Crs'1"j►tJr;�s �5, <br /> G b. <br /> E <br /> N <br /> E <br /> R e <br /> A <br /> T <br /> 6.W O <br /> W <br /> R d <br /> 1_ <br /> N <br /> G.Additional Descriptions for Materials listed Above H.Handling Codes for Wastes Listed Above <br /> Cott m— 'b20W" <br /> .r 0 �✓Q(r1 pb <br /> a <br /> Q15.Special Handling Instructions and Additional Information <br /> r T <br /> 1 <br /> Z <br /> O <br /> Z <br /> V r <br /> 16.GENERATOR'S CERTIFICATION:1 hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transport The malenals described on this manifest are not subject to federal hazardous waste regulations <br /> Date <br /> Printed/Typed Name Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R Date <br /> r+ <br /> A ed/Typed Name Signature Month Day Year <br /> S +� 1.�,, 1tc 3 <br /> PO 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> rr T Printe&7yped Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> .r A <br /> C <br /> 1 20 Facility Owner or Operator,Cemficahon of receipt of the waste materials covered by this manifest,except as noted In item 19 <br /> L <br /> Date <br /> rr T Printedrryped Name Signature Month Day Year <br /> Y f-k►c�AREI- 12 Ili <br /> F-14 02002 LABELMASTER® (BOO)621-5808 www.labelmasteccom tms, Rev 3195 <br />