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NON-HA2ARDOUS f (omv,,i,,Q+Numtvr :_PT_- <br /> 1 to 1 1 ntmt�nrr'ythm�nn,�111eq,a1WnUe hecMlrw N+NnUe►WASTEANIFESTC M D6 -T <br /> r lsv 7 !/� w �C _ <br /> S GeMradvs Name AV Ma1.q Aabntt /1�(� ISvnnr,u,i%ynn A411.%%Ig rer:l kin m,111111 If""'r) <br /> �/5 GtlOe9l/ Vyj �— �G✓� v �cLr�`l'I� �v /�V� <br /> 6Z efj TXT Ly <br /> Generales s r:h,,,ne �m 12 y Y <br /> 6 Than t cwt"1" 15 EPA iD Nrot 10.1 <br /> ' lr,y�prfel;Cmrinry 1L ---�U 3 EPA It1 fAxrAml - <br /> 5 Des-paled Fac,kly Nano ane See Adfess US EPA 10 Mentor – <br /> YYo70 CN/il t%, ID ' <br /> F *s Phone �r <br /> ffaZ I <br /> 9 Waste Shq q Name and Destrlpeon In CrY111111xtll 11 10 11 1? IJnn <br /> tin Typo O.r,7M'y PdI'cul <br /> cc kmv <br /> Q � 5• <br /> = 2. <br /> W <br /> V <br /> 3 — <br /> 1 <br /> 13 Special Harding In51W)arls and Avaml lmfwnaim <br /> P`( cQFcl CC -#:- <br /> 1!.GENERATOR'S CERTIFICATION:I certify the malonals described abm On tris manifest are nol sublocl to lederal repulalam tar iMnnma pruper 11,M11 d HatanSous Y1a.re <br /> Gen Wwzz <br /> N.ime , t_ Sgna+uro I,trnth p,� <br /> /W '� 1 'Inlr <br /> J 15 Inlemall0nal ShTmen15 <br /> ❑Import 10 U S ❑Expon from U S Pal o1 enlry"enl <br /> Transporter S nalure tv erports on I Date lea iing U S <br /> 16 Transporter ArknouAedgmeni d"I d Malerials <br /> Transporter t PrslledTyped Name Sgnalute <br /> ,�+ tAr,n1� Day yf.;p <br /> Transporter 2 Prm1 }ped Name Slgnave <br /> ir O1'/ Yr•:r <br /> 17 Discrepancy <br /> 17a Discrepancy trldicatan Space ❑ <br /> ❑Duant.ty ❑Type ❑Residue ❑Part at P.electrrl F,II PRlnrl,r,n <br /> MandOSl Reference Number. <br /> 17b,Alfemate Fanity(a Generator) <br /> U S.EPA 10 Num�r <br /> J <br /> u. Facil. 's Phone: <br /> 0 17c.STarure of Aaemale Fadity for Gene ator) tAomr. Day Yrn• <br /> a <br /> z <br /> n <br /> u <br /> 1 es nested Facd'y 0"Oner n%ereralOOf Ce*atim D ece+PI of matenals covered by the manifest except a rm 7a <br /> S <br /> Scanned with CarnScanner <br />