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?a <br /> NON-HAZARDOUS 1. Generator's US EPA ID No. Manifest Doc. No. 2. Page 1 <br /> WASTE MANIFEST of <br /> 3. Generator's Name and Mailing Address <br /> <br /> 4. Generators Phone ( ) ~ /~~ ~ <br /> 5. Transporter 1 Company Name 6. US EPA ID Number A. TrensporteYS Phone <br /> 7. Transporter 2 Company Name 6. US EPA ID Number B. Transporter's Phone <br /> 9. Designated Faciliy Name and Site Address 10. US EPA ID Number C. Facility's Phone • <br /> M \ ~\.L <br /> 11. Waste Shipping Name and Description 12. Containers 13. <br />To[al 14. <br />Unit <br /> No. Type Ouantiry WWOI <br /> a. <br /> ~ aay~S <br />E b P~ S -1 <br />(<~ ao,~ <br />N V <br />E <br />o ° c.c.s 3~~ any s <br /> <br />R <br /> tl. <br /> D. Additional Descriptions for Materials Listed Above + , E. Handling Codes for Wastes Listed Above <br /> i6. Special Handling Instructions and Additional Infonna[ion <br /> 16. GENERATOR'S CERTIFICATION: I certity the materials described above on this manifest are not sublect to fetleral regulations for reporting proper disposal of MazaNOUS waste. <br /> Printed/Typetl Name Signature nronm Day rear <br />T 17. Transponer 1 Acknowledgement of Receipt of Materials <br />R <br />A <br />" ~ tedRyped Name <br />~ Signature Manm Dey rear <br />03 <br />s c-~ <br />c~ ~ CA, X ~ /y a <br />P <br />O <br />16. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />7 <br />Printed/rypetl Name <br />Signature <br />Month Day year <br />E <br />R <br /> 19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L 20. Facility Owner or Operator. Certification of rece <br />ip <br />t of waste materialrs cover this man'rfest except as noted in Item 19. <br />T `` <br />ll <br />\ V r 1l~`Q' <br />V Pnne <br />ypetl Name <br />Signat re <br />nnonm Day rear <br />TRANSPORTER #2 <br />