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NONHAZARDOUS WASTE MANNtEST <br />Please print or type (Form designed for use on elite (12 pitch) typewriter) <br />}- .. <br />c —.t W j K1 r <br />4.Generator's Phone( 1 - 1 <br />5. Transpl I Company Nei Go US EPA 11b r AN State Transportere IDi <br />= f } km <br />G Y E�Y _.. <br />B, Transporter I <br />3•0 <br />7. Transporter 2 Company Name 84 US EPA ID Number CA State Transporat's <br />ON Transporter 2 Phone <br />F. Facility's Phone <br />iiN WASTE DESCRIPTION Total <br />Quantity13* <br />• <br />� 1=t <br />e Additional Descriptions for Materials <br />II ...-. for Wastes Usted Above <br />Numbw 46494 <br />ANN 20 2 YL" <br />ir <br />16Special Handling Instructions and Additional Information <br />ow <br />164 GENERATOR'S CERTIFICATION6 I here cerfily that the contents of this shipment are ful uda�c'tiratelj described and are In oil respects <br />In proper condition for transpon. The mate, Is described on this manifest are not subject to ederal hazardous waste regulations, <br />Signature <br />{ =i <br />t <br />1K year <br />Mw47Z All 71 ILI <br />r( .: <br />AN JAL/ <br />17. Transporter 1 Acknowledgement of Receipt of Materials Date <br />a 18. Transporter 2 Admowledgement of Racelpt of Materials Date <br />mol In, Ills rA , =#c le 3 Signature Month Day Year <br />t9A Discrepancy Indication Space <br />I Facility OwnGror Operator: <br />Printedtryped Name Signature Month .: <br />