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NON-HAZARDOUS WASTE MANIFEST <br /> ' Please print or type (Form designed for use an elite(12pitch)typewriter) <br /> NON-HAZARDOUS 1.Generators US EPA I D No. Manifest 2.Page1 <br /> ASTE MANIFEST A09 Dowmem No. <br /> 2D(d,I 1060I of <br /> It 3 Gaftarator's Name and Melling Adtlross <br /> 17. <br /> � , x} <br /> 4.Gen osPhone A� �j•�'��',�� .. �`� :'_A�, �u . ) f✓1. <br /> 5.Transporter 1 Company Name S. US EPA 10 Number- A.State Transporters ID <br /> f'Is_�a Y 4&M / ,1 e < :t.z va t� O I — B.Transporter 1 Phone -712-7-h 7 .-moi <br /> 5.Transporter 2 Company Name B. US EPA ID Number C.State Transporters ID <br /> D,Transporter 2 Plane <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.Slate Facility's ID <br /> LKa��= f <br /> 11o5C 1+�vaLf Ro <br /> F Facillty'c Phone <br /> til'! ' E � ,i as :•/(.�f.` '/ � -J <br /> 11.WASTE DESCRIPTION 12, Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity WLNOL <br /> e. <br /> 1 knk,117rak;lloce T?�;11 �. moo 25 C) �- <br /> G b. <br /> ' E <br /> N <br /> E <br /> io <br /> R d. <br /> �W <br /> '. G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Usted Above <br /> 15.Special Handling Instructions and Additional Information <br /> T 7A1 fiz %'l-#Ione' -W 707-374--_;'001 <br /> AffAffAWAWAVAWAWAWAIKAWAWAWAV / <br /> AWAV <br /> ' 16.GENERATOR'S CERTIFICATION:Thereby-lily that the contents of this shipment are fully and accurately described and are in all respams <br /> In proper condition for transport.The materials described on this manifest are not subject to'ederal hazardous waste regulations. <br /> Date <br /> Printed/Typed Name tr Igm6re Month Day Year <br /> 1?� <br /> T 17.Transporter 7 Acknowledgement d plpt of Idaterals n Dale <br /> NPdnled/ryped Name Signature y;..��Month Cay Year <br /> p16.Transporter 2*linowledgement of Receipt of Materials Ogle <br /> TPrintedrryped Name Signature Month Day Year <br /> R <br /> F ISS <br /> 19 D �aParioy Indication Space <br /> A <br /> C20.Facllity Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in hem 19. <br /> I 1,I Date <br /> TPrinlad/lype J6{C� l / ._..Signature 7jjDay ,;r <br /> 1 " 1 <br /> F-1402(x12 LABELMASTERes (8001621-5808 wwwlahelmama­ -A <br />