Laserfiche WebLink
MgRDforusean • " >.rM�j 1 C MHIVIrtJ <br /> NON_HgZ elite(12 pitch)typewriter) <br /> WASTE ANIFEST Generator's US EPA ID No. _ <br /> Manifest :.Page 1 <br /> J Genwistor's Name and Mailin Address Document No of <br /> 4.G•enneralr0l s Phone <br /> 5.Transporter 1 Company Name <br /> I D O41 ., 6. US EPA ID Number A.State Transporter's ID <br /> ----------------- <br /> f h c <br /> 7.Transporter 2 Company Name yFG �^ '� B.Transporter 1 Phone <br /> 8. US EPA ID Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address <br /> �t(�y�yL�;t. 10. US EPA ID Number E.State Facility's ID <br /> "'Lt.S"'W�+ F. Facility's Phone <br /> i AR171}4.)0994iit,. <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Unit <br /> Total Wt.Noi <br /> No Type Quantity <br /> a. <br /> l,.%JID SUMP Wf STVL) <br /> G <br /> E <br /> N b. <br /> E <br /> R <br /> A <br /> T c- <br /> O <br /> R <br /> d. <br /> H.Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above <br />' <br /> 15.Special Handling Instructions and Additional Information <br />• t #F rA NC t rihli!�;I !;►{{t�[;:.t�; 1-it�4rA ��xfi�31 �.F ��� � Pi#����� *A;'fi�t?tii�t?IATi. <br /> pfton+ ri1JC fl 'WI f <br />� +i'I=.,,i'fc r•{ ,r f't�¢F' ':Tf�{'�r''f'�p,f �`'as ti'T�!#f�f <br /> GENE <br /> ly <br /> are in <br /> ects <br /> 16-n proper condition oritra sport The materials certi described o that the onntents of this shipment are th s manifest are not subjectly and t federal and state hazardous waste relgulations. <br /> Date <br /> Printed Typed Name Signature Month Day Year <br /> r 17.Transporter 1 Acknowledgement of Reciept of Materials Date <br /> R Printed Typed Name Month Da Yee <br /> A yp Signature Y <br /> N <br /> rter 2 Acknowledgement of Reciept of Materials Date <br /> ad Name Signature Month Day Y+ <br /> epancy Indication Space <br /> 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> T Printed T Date <br /> Yped Name <br /> Signature Month Day <br />