Laserfiche WebLink
! r NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS /.Generators US EPA ID No. Manifest 2.Page 1 <br /> WASTE MANIFEST , . ( DocumentNp.�y of <br /> I 3.Generators Name and Mailing Address fa R Q .S <br /> LnTO <br /> ZbtoZ RIO. WILSON UJAY AD`trNC�:� au F_NV <br /> i <br /> i 4.Generator's Phone( ) STC lCTUti Cil <br /> 5.Transporter t Company Name r 6. US EPA ID Number A.State Transporters ID <br /> ' rSS I�f�T J[VCB.Transpo & <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.Slate Facility's ID <br /> t isl-,7w�mis. <br /> --- <br /> Il 5 C A&W-C RT RD, <br /> F.Facility's Phone <br /> F�:-0 `k rA 9;671 ,?ea7}X7 4 <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt./Vol. <br /> a. <br /> Sol L } 1) S I20 Di211 t� <br /> Tb NS <br /> G b. <br /> E <br /> N <br /> E <br /> R c• <br /> A <br /> T <br /> O <br /> UJ R d. <br /> H <br /> N <br /> aG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> Boownlj IGn. i �}EEZ,('�I�`f NO o-r)cR <br /> i <br /> O <br /> 0 w Ru CT.1 C!J 'D r 31215 <br /> NQ 15.Special Handling Instructions and Additional Information <br /> Z <br /> 0 <br /> Z <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 /> Printed(ryped Name Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> A Printed(Typed Name Signature ,//� / Month Day Year <br /> C) 18.Transporter 2 Acknowledgement of Receipt of Materials t Date <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> i 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 Printedrryped Name Signature A 1' th Day Year <br /> Y 1c Nxa£L +vJ�l1T i It!a4> �-E=� .x'--;1 &41h <br /> S 141 <br /> F-14 02002 LABELNIA TERO (800)621-5808 www.labelmaster.comRev.3195 <br /> u�na wnn <br /> SOYINK„ <br />