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<br />NON-HAZARDOUS
<br />WASTE MANIFEST
<br />1. Generator ID Number
<br />N/A
<br />2, Page lof
<br />1
<br />3. Ernergenc? Fiespcnse Phone
<br />877-236,8265
<br />4. Waste Tracking Number
<br />2-26029,5014
<br />6,10 mrlegiaNytioniaiNnivg id&
<br />pa! Uties :Division Generator's Site AddreesTri different Ifian mailing addresS)
<br />747411NA-nicii-liOti-St.'...
<br />Stc/cktOir CAIRO': , . . .. . ..
<br />Genotalor's Phone:
<br />Transporter I Company Name US. EPA ID Number , Ponder' Environmental Services 1 CAR0001 80 731
<br />Transporter 2 Company Name US, EPA ID Number
<br />I
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<br />D a Vit:f ro
<br />Saw
<br />FacilitVS Phone:
<br />,41101).1r,ts, U.S. EPA ID
<br />CN-94585;.;
<br />7W 4 2-4d27 .1 • CA- .
<br />Number
<br /> 6
<br />Waste Shpping Name arid Descdplion 10 Containers 11. Tata, it Urn
<br />No, Type , — WI.Noi:
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<br />Arisiitional IntonnaiiOn --.--,:
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<br />}90:1244P.P 1 -
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<br />14: 4ERATOR'S1OFFEROR 'S CH il6ltiVlititit I hOitiidsiare vikt the contents of thts consivnientareittlY 10 liCon
<br />marked and labeledialaratttect, and ii r8npesmprcondlItry11ar transport amording:tp_app64% interne [tonal 611 . 4.4Y. 00 Peort0.1,sh*ifinarn.e,. nd are classified, packaged,
<br />- jfirgtgli10.1460.6.
<br />Genaralers.101ferma print 1) . . • " ,,... i Sloriettse :.i • tOtith Day. ar ,,„
<br />4.:401,M1/1.At ihtematione aaiiimetus.
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<br />. . a opon.10 ZS.•lena D:s. Port 0144001!
<br />Transporter Signature (for exports only): D418%441341 111ANSPoliTER• Y; 16. Transpolar Acknowlederitori fdfier*.1:91.t114141** ' .Transpotter.1 Prtiffecayried Nate Situating - . . .-, MOntli _Dor ,_ Yost 17 f4C......
<br />Transperter E Panted/rod, Name Slpnatr.re Month ctair Year -,
<br />1 1
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<br />17, Discrepancy.
<br />17ii. DISCiepancyjcake . r--1— t,
<br />L_I Parnat RejecIion
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<br />- Typo Retidue L-TRIII'Floroction
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<br />Manifest Reference Netter;
<br />k •I1b414101# FONY(ietolloraloi) U.S, EPA ID Nurn4p:'
<br />Frogs Phone:
<br />17c, Signature at Alliffigefac.160 (Or D6hFrater)' MOM ... .
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<br />4 -- . -- -
<br />16. Designated :Pack (*nor or Opeoelor Cartificatianot receipt elm enals . red by the manifeet except as noted in Horn 17a
<br />Signature
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<br />PrInted/Typed Name
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<br />169j13LC-O 6 10498 (Reit, 9/09)
<br />DESIGNATED FACILITY 10 GENERATOR
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