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NON-HAZARDOUS 1. Generators US EPA ID No. Manifest Doc. No. 2. Page 1 <br /> WASTE MANIFEST o1 <br /> 3. Generators Name and Mailing Address <br /> 6nergp Pnels Coal Inc. <br /> 4. Generators Phone ( ) <br /> 5. Transporter 1 Company Name 6. US EPA 10 Number A. Transporters Phone <br /> 7. Transporter2 Company Name 8. US EPA ID Number 8. Transporters PMne <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone <br /> 11. Waste Shipping Name antl Description 12. Containers 13. <br />Total 14. <br />Unit <br /> No. Type Quantity WWoI <br /> a. I <br /> PCS BULK !*18 <br />r, b. <br />E <br />N <br />E <br />R <br />A c. <br />T <br />O <br />R <br /> d. <br /> D, Additional Descdptions For Ma[edals Listetl Above E. Handling Cotles for Wastes Listed Above - <br /> 16. Special Handling Instructions and Additional Information i <br /> <br /> 16. GENERATOR'S CERTIFICATION: I cenity the materials described above on this manifest are not subject to fetleral regulations for reporting proper disposal of Hazardous Waste. <br /> Pd yped me ~ -. Signature r r rtfnrn oay rear <br /> <br /> <br />T 17. Transponer 1 Acknowledgement of Receipt o1 Materials - <br />R <br />A <br />Pnnted/Typetl Name <br />Signature <br />Month <br />oay Year <br />N <br />S <br />P <br />O <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Prtnled/Typetl Name <br />Signature <br />Monts <br />Oay veer <br />E <br />R <br /> 19. Discrepancy Indication Space <br />F <br />A <br />C <br />t <br />~ <br />I 20. Facility Owner or Operator: Cartitiwtion of receipt of waste materials covered by this manifest except as noted in Item 19. <br />7 <br />r <br />Printed?yped me <br />Signature _ <br />Manm <br />4qr Year <br /> Q <br />GENERATOR'S COPY <br />