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4 ;.1 GENERATOR L NON•HAZARDOUS
<br />WASTE MANIFEST
<br />I. Gen°21(x ID "umber N/A
<br />2. Page 101 3. 6rFre%rency Response Phone
<br />877-256-8265
<br />4 Waste TrackIngtitimber . , , . :
<br />22-264394001, 5. Gerieratort Name and MalingiAddrete Generator's Site Address (if different than maIhrig addreSer ".. '."' '7'" ' '''. ' • ...14st.St=iciii.MUnldpfli. WINN 9 ••• k
<br />200001702115206'':
<br />Garteratieg kiefiet..:',.:''''' '.. 44:19, • 6, Tranepoder 1 C.onisany erne • ' U.S. EPA ID Ntrrnber
<br />'. :PilikkirJEitfiromentiliSevices.. •
<br />1 , GAR.o..9,01,00,73.7 Traniebdef 2 Carri4 Naffie VS, RA ID t4Iipibei
<br />Designated Facility Nape and Site Address US. ERAIO-Nissilier
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<br />' 307:506Witillb.IIV -'.-
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<br />13. Special tlerrOing Instrucrions and Additiorrel.Intermattorr
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<br />,14i.GENERA1DRI/OFFEy10frt. CERTIFICATION: I hereby deciare that tile oontepts of this consignment are hilly anciPCO.:yrAteli described above by IQ prQerSt pri tiOsi(!,* are :crottiriii,A0904, 'rrie.r1tod and labeledtpli*ed 04 4te lit all respects In proper cdnoten- far yahllicti.1 axording to applicable Internittlebalarfd national goveininercal , ..,. ". Goperatoest011etoes Printy..(1rpod Name Signature. ',.' I,.- ' 00000° . . .
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<br />Import to U.S.
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<br />111 Eiport from U.S1 ' Plyil Mentri/Oit. .,...._'' 1-' - 'Transporter au4naluiS Or axjaoris only): 'fill Itissinq US.:
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<br />T let :I PrinICIT,Iipci?,iiiii4' .. )444.t1,::':_yili.: fit;
<br />', .:-.Tanapciitotg-:piOgrAticr,voio $.10-niiimiii. • • - .mou, -pay ' Year
<br />..... 2:- • • DESIGNATE() Facit_rrt 1/. ,Discrepan4r .
<br />17I;OlsCrefk(ncy liti.CalionSfadif
<br />Quanaty DTVPO
<br />Manllt.Fiel
<br />Residee Partial Refection DFuRe1ecelon
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<br />prance Number:
<br />174. *AllernMe Fatitify careartereloif U.S. EPA ID Number
<br />FacIlltli PtiOrra: ,
<br />176 SIgnalvie Of Alternate Ficility (or Generator) ,M0ntP22 '..' 9K. .. ': Y . 17
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<br />12. Designated Faarry 0•NrvIr or Operator. Cert, 'cation of rect-i . .1 mated& coyered by the manilest eicopt as noted in I 17a .
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<br />16£1440-0 6 10498 (Rev. 9/09)
<br />DESIGNATED FACILIT TO
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