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L� <br />NONHAZARDOUS WASTE MANIFEST <br />W <br />Cl) <br />O <br />cc <br />a <br />N <br />4 <br />z <br />Z <br />Z <br />oi„n«ndnt nr tvnn Wnrm desioned far use on stile t12 Vituni tVpoWriler) <br />CF14 Of 2002 LA6E4{v{ASTE12 °O (800) <br />NON -HAZARDOUS 1, Generator's US EPA 1D No. <br />Manifest <br />1 <br />Page i <br />"' <br />WASTE MANIFEST-`'s.4t;i?:rj °I <br />DocumenfNo.;#t z <br />of # <br />3. Generator's Name and k4ailing Address <br />�FLL { tf-�E�•���tY�l{H.Trr�rk•�f'2iCk� <br />4. Generator's Phone <br />5. Transporter 1 Company Name 6. <br />US EPA ID <br />Number <br />A. State Transporters ID <br />9, Transporter i Phone_'Zwfh <br />i <br />7. Transporter 2 Company Name 8. <br />US EPA ID <br />Number <br />C. State Transporter's ID <br />D. Transporter 2 Phone <br />9. Designated Faciiity Name and Site Address 10. <br />US EPA ID <br />Number <br />E. State Facilitys ID <br />tttt <br />2 6 t3 r' �'.�S. <br />�� <br />F. Facility's Phone <br />-� <br />11. WASTE DESCRIPTION <br />Containers 13, <br />Total <br />14 - <br />Unit <br />No. <br />Type Quantity <br />Wt.Noi- <br />Maja4lazxkldou'r Was -21, Urpild <br />1 <br />G <br />b. <br />E <br />N <br />E <br />R <br />c. <br />A <br />T <br />0 <br />R <br />d. <br />G, Additional Descriptions for Materials Llsled Above <br />H, Handling Codes forWastes Listed <br />Above <br />tlri i�it.rn tr.3 <br />15. Special Handling Instructions and Additional Information <br />JWJW <br />MAW W IN <br />AW <br />M MJWMM <br />W <br />M <br />M <br />ME AN AN <br />AN <br />16. GENERATOR'S CERTIFICATION: I hereby certify that the contents of this shipment are full yy and accurately described and are in all respects <br />in proper condltlon for transport. The materials described on this manifest are not subject to foderat <br />hazardous waste regulations. <br />fig <br />Date <br />Pdntadri ypdd Na�riQ <br />Signature <br />�r <br />Month <br />Day <br />year <br />f': <br />oil <br />TR <br />17. Transporter 1 Acknowledgement at Receipt of Materialsr <br />1': <br />Data <br />A <br />Pd tedji'yp#ed Name <br />Sig <br />j <br />l <br />FM ortth <br />;Day <br />Year <br />WooP <br />0 <br />18, Transporter 2 Acknowledgement of Receipt of Materials <br />Data <br />R <br />T <br />printodrTyped Name <br />Signature <br />Month <br />bay <br />Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />20 Facility Owner or Operator: Certification of receipt of the waste materials covered by this manifest, <br />except as noted in item 19. <br />Date <br />T <br />Printedrrypad Name <br />Signature <br />Month <br />Day <br />Year <br />Y <br />621.51308 www.labelmaster.com <br />�OYINK <br />t us cue->rexn+ew <br />