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r i ' <br /> ' NON-HAZARDOUS WASTE MANIFEST <br /> Please tint or '�.e ' <br /> p type xr(Fo'�edgned for use on efile(12 pitch)typewriter) <br /> NON-HAZARDOUS 1.Generator's US EPA ID No. Manifest 2Paga1 <br /> WASTE MANIFEST NI)? Document No.201!0 0� <br /> 3.GAenannor's Name and Mailing Address 7 N <br /> 6'-/ r <br /> acd.yLa �a ,);c 44c. p <br /> /3P, -teH��c>'SQ.n/L- <br /> /v41,P1 6r149<A <br /> enamtors Phone <br /> •.5.Transporter l Company Na� y 6. - US.EPa.I Number A.Stale Transporter's ID ' <br /> E!�'x �12JP."` TkCaF VQ- 1.2AD0,71,4 YELZO B.Transporter)Phone —707--321 <br /> 7.Transooder2 Company Name B. US EPA ID Number C.Stele Transporter's ID <br /> D.Transporter 2 Phone , <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> /IUe✓(i ljIt,Jr4) fI RLQ <br /> / - F.Facility's Phone ' <br /> 11.WASTE DESCRIPTION 12. Conlelnem 13. te. <br /> Total Unit <br /> No. Type Ouentlty WINol. <br /> a. <br /> �I,iY)Y)-.T ,':t)v�A�!•A! ��7'1�jt w� PtfA� f•'fl C7!Q�•y. � l�Q , <br /> G b 'E <br /> R <br /> A <br /> T, <br /> 0 <br /> W <br /> R d. <br /> �(J) <br /> 'a G.Additional Descriptions for Materiels Usled Above H.Handling Codes for Wastes Usled Above <br /> 0 <br /> O <br /> D <br /> N <br /> 15.Special Handling instructions/,7k <br /> Additional Informallon <br /> i��hU LpC ;* 70 7 0 7q- 90/ <br /> Z <br /> O4 v <br /> 16.GENERATOR'S CERTIFICATION:I ham W ceNiy that the contents of this shipment are fully and accurately described and are in all respects ' <br /> in proper condition for transport.The materials described on this manifest ere not subject to federal hazardous waste regulations. <br /> Printadrfyped NemeSI atur Data <br /> 0 Month Day Year <br /> y�Gt.!• G 13Lv7A �O'"Ir.'i Al PQGI, r _L�,_ �' ---. , <br /> T 17.Transporter I Acknowledgement of Rectiof Materials / <br /> R Date <br /> N Pnnted?yped Nature Signature'' ! Month Day Year <br /> yy pI <br /> P 'Ii .r C•( C• r)l`,,..,r r .i,.., r ^z:�.r)r <br /> p 1B.Transporter Acknowledgement of Receipt of Materials <br /> R Dale <br /> PrintedirrypedN me <br /> E Signature Mdnth Day Year. <br /> 'R <br /> _ . . . .. i <br /> 18.DIs�3iepancy Indiballon Spade <br /> A _ <br /> 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. ' <br /> j1. <br /> Date <br /> T Pdriled/TYped Name•, C / t a <br /> Signture <br /> Y Manlh year , <br /> cu ` �U ir, <br />