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W <br />H <br />N <br />Q <br />D <br />O <br />0 <br />a <br />N <br />a <br />1 <br />Z <br />O <br />Z <br />77 7 5, Lout <br />N*HAZARDOUS WASTE MANWST � Q <br />Please print or type (Form designed for use on elite (12 pitch) typewriter) <br />CF14 © 2002 I.AKLi$1ASr @ (800) 621-5808.www.labelmasteccom ®rraxreomu.crcao vrw <br />usmc wyvu 1. INK <br />NON -HAZARDOUS <br />1. Generator's US EPA ID No. <br />Manifest <br />2. Page 1 <br />WASTE MANIFEST <br />Document No. .� .1 <br />Of <br />3. Generator's Name and Mailing Address - - <br />:3x:xill�`iY 'i'iT lit <br />W �t •i i t 1,' 1)V TT*0 <br />yy �fyry �ppyg��pp��yr333,rk� <br />4. Generator's Phone ( (?t1)J) ` 9t) -6666 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />A. State Transporter's ID <br />M If: LANtNI N:WW1tNAWK NC I 1 Ifs Ct 8 :e 1 2 g i <br />B. Transporter 1 Phone ; ' 3 r <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />C. State Transporter's ID <br />D. Transporter 2 Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />E. State Facility's ID <br />9999 21111TU AUSTIM MAD <br />F. Facility's Phone <br />efAO iTVA CA 4VT <br />C' f1 1'. 14 it fi t +1 11 It ii It <br />11. WASTE DESCRIPTION <br />12. Containers <br />13. <br />14. <br />Total <br />Unit <br />No. Type <br />Quantity <br />Wt.Nol. <br />9• t3 <br />Q � V � l <br />G <br />b. <br />E <br />N <br />E <br />R <br />c• <br />A <br />T <br />O <br />R <br />d. <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed Above <br />15. Special Handling Instructions and Additional Information <br />al, :: r'- T:(s '.R kT : }..2'`XA -.{}' .. <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 ' tedrryped Name <br />S' n Month Da <br />YW <br />a9 /� .-�fz <br />,, r ���- / �- rT <br />a <br />T <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />A <br />Printedrryped Name _� <br />SignStu Month Day <br />r <br />Year <br />lef <br />0 <br />p <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />Date <br />TPrintedrryped <br />Name <br />Signature Month Day <br />Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />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 <br />Printed/Typed Name <br />Signature Month Day <br />Year <br />Y <br />CF14 © 2002 I.AKLi$1ASr @ (800) 621-5808.www.labelmasteccom ®rraxreomu.crcao vrw <br />usmc wyvu 1. INK <br />