Laserfiche WebLink
Please pdat or type.(Form desi nod for use on eito 12-pitch)ty)ewriter.) Form APploved.01118 No.20E0-0038 <br /> UNIFORM HAZARDOUS 1 1�.+C6ft,mttO"O NN"h" 2.page r of a.Emsrp9ncv Rasponse Phone C Wilful rackin nmber <br /> tYA57EiN{INrFE$f �s1�I I k/ZO'0 ,012-1 — 1 111 �� 002900475 G B F <br /> Gert or s Nam%arA t leiYng Address CieneraW5 Srle AMtess(it ddfam Clan;Wrg address) <br /> 141 - <br /> q� <br /> 41 Y�vo `1gb�5 COY ( <br /> Genereloes phone: K- 4 2 <br /> 6.Treospoder 1 CAfipeRf Name U.S.EPA ID Number <br /> w fl; c GLi C10. cv 3 to7�42 <br /> 7.lransporter 2 Company Nam% V U.S EPA ID Number <br /> 8.DD*nated FadIdy Name and Site Address U.S.EPA ID Number <br /> F�Phone: � 93'(p <br /> gg ttb.U.S.DOT Dexmpdw pWudHV PgwSbt*Name,Hazard Gass,10 Nnbar, 10.Contah03 <br /> and P 11 Total 12,Unit 13.Waste Codes <br /> HMaekng Group{If any)) No. Type Quantity M.Nd, <br /> z 2. ., <br /> f <br /> 3. <br /> d. <br /> t� <br /> 14.Spooiol Her dSnq Jneouctlont and Ad dirt Inbrniabon <br /> f�C =i�- {-Z I <br /> V�.Ier-- Q+-O(-&w <br /> 15. GENERATORMFFEROn CERIVICATiON:l heresy decim that the contents of W*maslgmrenl ars fully and accurately dwrbW above by N propor affpping name.and ars dawaad,pa*dged, <br /> marked end labeledlpfaarded,and are In M respects it ptaper mrKhon For transport accord4q to applicable InWma6olrel and ralknel ymemmental rop[800na.0 arrpad sh¢xnant and I am ties Primary <br /> Fxpvrter,I c e*Clot the coaleklt of this cronstgruserd conform to the iemte of the altedled EFAAdzcw!edgmaM N 9"nL <br /> 1 cwU(y 5%t the wssta Arfrnhetian al meed IdendSed N 40 CFR 262.27(a){81 am a large qw tty penelatak)OrKV I a amag quay.v goneralor)Is bue. <br /> GaaerekarYKftQ?8 ft adfT Mamie Signature Month Day Year <br /> ' 16 2cr} <br /> 16,WamaWnst shrpnror4 <br /> ❑ImpoR to U.S. �FFxport Gas U.S, PM of <br /> of erltryfexib <br /> TwwpolVigrlatere(for ezportsowy)' Da1s laming U.S.: <br /> 17.rranspo Mani dwladgmentof R=4A oflMalertats <br /> Trel�yerSUPrkaecUly�ped�l' Sol Mom yOay Year <br /> a ('K(J :1!� 4,,�- <br /> t <br /> Q rampoder 2 PristedlTy*Name Signature Niantll Day Year <br /> t:r <br /> r <br /> 18.Disaaparuy <br /> 1 Ba.Disrrapaacy Wcatba Space Quartbty ❑Type ❑Resklue ❑Partial Rq*wn ❑M Rejection <br /> Manifest Reference Hunber. <br /> 18b.Akemale Felty(or Gawator) U.S.EPA ID Number <br /> r <br /> U <br /> Ferny%Phone: <br /> tSa.SsgrtalareorMsmate Faddy(or r3ersPralor) <br /> Day Year <br /> y1 D.Hezaldooa Waste Report Iaatagemenl Neemd Codes(LO,aures for tra Ndws waste hatffwo,disposal,and regJing sysle%ls} <br /> t. -fir�l � - -3 - 4 <br /> Om(pneladFarXilyOWnecor!)paretocCarkkafwnOrmtPLdhazardw.wtudsis«meadby"n,mAkeq pbo aWed to"am lea <br /> MOO ,arse Signaler% Month Day Year <br /> it <br /> EPA Form 8700 ev MS) Previous editions are obsolete. <br /> n=CJnal ATCM CA Atl ITV Tr'�RCrrt/,t AYtnat n-rkrr- nr <br />