Laserfiche WebLink
ar <br /> Please Print <br /> or'pe.(Fant designed for use L, lite e (12- itch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM NA2AR0003 LGtnerator lD Numt-ae 2.Page'af 3 Emergency ResDonse Praia IA.Manifest Tracking Number <br /> WASTE MANIFEST JJK <br /> S.Genera <br /> Name and MaE�gAdtlrega Gereruces But Address h neem I a aucg adaresst <br /> Generator's Phone: <br /> 6,tmnsppder t ComFany Name U.&EPA 0 NOR <br /> ?,Tgt:ipdfsr2 CAmpanp Aianle <br /> U.S.EPAbO Number <br /> DEC 0 S 2016 <br /> B.Designated Faa71y Oar a and She Address U.S.EPA ID Numbs! <br /> , <br /> EWIRONMENTAL HEALTH <br /> Faar(a Phone- Prr-".;�; <br /> ga, 9b.U.3,001 Oe,cl Tn pndusGlg ProPon Shipping Nam,pszard Class.10 Number, 'c.Can:zmers 11,Tow 12.Unit <br /> HM and Packing Group fif a,y}? No. Top! Quandty WINd. 13.Waite Cuts <br /> ce <br /> q <br /> �VAS//T��fTAW BEN NAMED <br /> DU <br /> y r <br /> VOR 151' �917GAREA I' ENTS AT`. r <br /> IOeMENNOtKE[taU N14%l IN0DIOPTON, <br /> HAN9=SM <br /> f"' PINTS TO RECEIVE YOUR WASTE ST{kIA:*M <br /> �t�.�a�w'1>yc.5•:aLAT01 <br /> 4 <br /> eau:�r+.+W..e>..a,.�.av'.i::'F.+w`to o+wxM.,M,•.H�4n.yerN!� .. _. ._. <br /> 14.Spaaiai Hanbling Intimations and Addi3onai Infomlaaon <br /> 7 ?'tsrl trr•:, Y-S Y, -/1-.=„tOJItA F4 rS .:.r.; 'P.z'4YiCL±e 3#31 .?k57eBQ PFA`tF . •,t`r.?T <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contemnof:.Kscanaignmaa are fulty and aaunate�descrbed about by the Proper shipping name,art are dassfied,packaged <br /> marked and lab@tadplausted and twin a$respects in indoor condition forlransPoa 3cra169 toatoamble inlerteUd7alandnMorri govemmantai regulations.It agon shipment and l am.the Pnmary <br /> Exporter l ca6fj that the mnienis of tinecambgoment confirm to Urs tart,,of a anached EPA Ac <br /> of Consent. <br /> 1 cardfy that thewasm minknization state nanl idempiap in 40 CFR 26237(a)M i am a Um quantity generator)ar(IN(etam a$m sI quaratygenera'Axj is Iry a. <br /> Genarafars'Ofaa's enntedfiyped Name 'n'., ' ', ': .._... Sgnature '... .�.: •..Month Day Yea <br /> t6.INarnac Prat Shipmai5 �7 <br /> r- - ❑JmpodU U.S. UExPor{tmm U.S. Fort Gf e11ry1axit <br /> T-.nsP�e'sg2::a2(iw axions onhfl: , wit. US:: <br /> 7'.Trarspp;ierngru.+r7Edo n4cf ofblise fofMalasits <br /> old <br /> T!anspona Prv4,edlTypaa Name Signawe r, Mom Day Yea- <br /> N -. . • -- - * ..w^; zu-'..�.; . . <br /> Z iransPCRa'2 Pnlntadrypeq Nana Srgdature Morro -D a; Year <br /> tib <br /> 1$.ORcaFancy , <br /> las,Msarawq Ndketal Spate �I <br /> Qusnp`y, DTYPe ❑Rsiidta f,�Partal Refection Futl RyecSan <br /> Manifest Reference Numter,7$S.Al:±male Fedw(y(m C�narakn) U.S.EPA(Q Number <br /> a. <br /> U <br /> u Facity's MT,pne: <br /> sn Me,Signature OfXtemate EacUry ler Generator) Mgilh Da Year <br /> G y <br /> Z <br /> US 1S.Naza:dcw.tNaste Report Maregamert Method Codes(Le.,meat fvharardaus•xasta ueatri ditpaaa,and recycling systems) <br /> 0 3, 4. <br /> 2A.Denigrated Fetialy Omneror Operator,Ca'Jeddlian of mmipt of ra_ardous mor;enols c:vexd by the mann;aaSaxmpt as need in Item lBa <br /> P+meu'yptd Norma Signxh+re Momh Day Yea, <br />