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NOAAZARDOUS WASTE MANIT <br /> Please print or ty,a (P,,rm designed for use on elite(12 pitch)typewrRer)' <br /> NON-HAZARDOUS F1GZ.neratr'sA US EPA ID Na. Manifest 2.Page 1 <br /> WASTE MANIFEST -y -L� Document No. <br /> w,i of <br /> 3.Generator's Name and Mailing Address <br /> X04 � e C,.0 i k <br /> 4.Generators Phone( ) Sinn <br /> 5.Transporter 1 Company Name 6. US EPA ID Number 1t A.State Transporters ID <br /> c fat0 0-Z& B.Transporter 1 Phone eloo. Q44-ILLa <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporters 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 /> A4aptKVNM-T LPOII)C:tL�_ <br /> 0 4btAVrl�LT r�'r�H'X P A6t, ED fW F.Facility's Phone <br /> L_\q M I ''1455 C@tl�> C14M 3 -L 9Z,—*- 44R -63wl <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> ,��' y No. Type Quantity Wt.Nol. <br /> a. Li QL 1'Q �14J R,1" . +:1 +(Kj'" 41D r� OD i <br /> 1 <br /> G b. ` <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T <br /> O <br /> W <br /> R d. <br /> N <br /> aG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> D <br /> O <br /> D <br /> OG <br /> Q <br /> Q 15.Special Handling Instructions and Additional Information J*eVXnp" COATAC a C4AeMT Jj p <br /> 0 m F'%GMS , ' r�tjc fLA 41157.v5 <br /> 11.1 <br /> AFAWAFAWAFAWAFAWAFAVAFAFAWAVAWAVAVAM <br /> 16.GENERATOR'S CERTIFICATION:I 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 materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> \P�rintedd//T`y�ped Name Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials j Date <br /> R <br /> A Prin yped Name Signature i:'' Month Day Year <br /> N <br /> S v <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Ree4Apt of Materials Date <br /> RPrintedrr ed Name Signature T Yp 9 Month Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space <br /> A <br /> C <br /> 1 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L <br /> Date <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br />