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NO -HAZARDOUS WASTE MANFYST <br /> Please print.or type (Fdhq dpsigped for use on:aflSe.(#2 itch)typawdtpr} - - - - <br /> NUN HAZARDOUS 1-GeneratorsUSEPA lbNo. Mar€est 2.PeigeI <br /> �{ � �"'' [+�^ Doli mengtt No. <br /> WA FYrA�1j-ES l <br /> 3.Generato-s,Na a and Mailing Address <br /> �P 4"")Wfll}GiG-... C:C1 w,-a iL.7+lff. <br /> 4.Generators Phone <br /> 5-TrarRspp(ter 1 Company Name S, US EPA FD Number - <br /> A.MatoTranstwder's ID <br /> e:Tratlsp4rer t Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C-State Tran <br /> sporters10 <br /> Q:Transporter 2 Phone <br /> 8.Designated F*Mllfl r Name and Site Address - i D. t!S EPA M Number -E.State Facility's EO - <br /> F.Facility's Phone <br /> 11.WASTE-DESCRIPTION - 12. Caritainers .13.. 14. <br /> Total Unit. <br /> No. Type Quantity L7V,VoI. <br /> a <br /> G b- <br /> E <br /> Q� <br /> f�ft43 ` Jl t '3 .wf� r�9t • ie <br /> ia <br /> R �• F <br /> A <br /> .0: <br /> LL[ R <br /> H <br /> U) <br /> QG.Additfonal.DescrlpNoms For Materlalstisred Move -H.Handling.Codes fur,Wastes-Listed Above <br /> a <br /> N <br /> 15.Special Handlksg Instructions aildAQdliunaJ information � <br /> a <br /> z - <br /> 0 <br /> z <br /> 16.GENERATOR'S cEATFFI6A.T1oN.I hereby certify that tfte cofiierils of ibis shipment are fully and acrwrataty described and are in all respecis <br /> in proper condition for transpviL The matenafs tlescftbed an this manifest eta not sublecl to Federal hazardous waste regulations. <br /> hate <br /> PrintedrTyped Name Signalum, mono flay Year <br /> °T' 17_Tmnsponer1AcknoMedgententofRece41ofMaterats Date <br /> R <br /> _A PriniedlFypedName <br /> aiure Mantic Day Year <br /> S ° <br /> �^" C <br /> P L *rte to <br /> p 18.Transporter 2 Acknowledgement of Receipt of Matcrtals Date <br /> TPrintedrTyped Name Signature Manch Day Year <br /> E <br /> F1 <br /> 19.Discrepancy indkaf§an Space <br /> F <br /> A <br /> C <br /> 1 20.Eacikiy,Owner or Operalor,Cerftfkation of receipt of the waste materials coverod by thlsmanifest,except emoted In 19. <br /> L <br /> ) 1 r T1.' ✓�.t f Data <br /> Prime N s Si nature ^ <br /> P / 9 MonthD Yea r <br /> /51/1 <br /> F-14 02002 LABELMASTERM (800)621-5808 www.fabelmasterxwn _ Rev.3195 <br /> mraamr <br /> ray.•� <br />