Laserfiche WebLink
4 mra�•e Frat <br /> �wnus .,:- rcme Nombes _ <br /> F r <br /> f i WASTE MucNIFEST <br /> b.6aneretors Name and Nedmg Atldrea �C n,rotors Site P.ndr_..Ir,di lereni t iai malting eddres) <br /> �G t Ph <br /> . 16.Transporter 1 Company Name U.S,EPA ID Number <br /> r 7 Transporte.2 Company Name !LS,EPP.ID Number <br /> !+! i <br /> I ! ` <br /> 6.Designated Facility Name and Site Address .- t U.S.EPA ID Number <br /> t I <br /> �W.k. 3 <br /> Facility's Phone: <br /> 9z 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit �G <br /> FIM and Packing Group(If any)) Nn. Type Quantity WWoI. <br /> o <br /> a� <br /> z z. <br /> Ilia <br /> 0 <br /> 3. <br /> 4. <br /> 13.Special Handling Instrucoons and Additional Information <br /> lit'1.hl'jlll A tsr;tft"Ifi ,P'E,A1'f f*:714 l_pgI% Fit a.d it e- <br /> 3_i�3f,% 41 - <br /> 14. GENERATOR'S CERTIFICATION: I certify,the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Generatotsi0ftror'sPrinted/fyped Name Signature Month Day Year <br /> J 15.International Shipments <br /> i— ❑Import to US ❑Export from U.S. Port of entrylexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 16.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Ppeedi Name Signature a: Month Day Year <br /> . y <br /> iiQ Transporter 2 Ph Name .Signature - Month ay Year <br /> K <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residueje l� <br /> ❑Partial Rejection LJ Full Rejection <br /> Manifest Reference Number: <br /> 17b..Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> sa 17c.Signature of Alternate Faulty(or Generator) Month Day Year <br /> Q <br /> 2 <br /> Cl <br /> to <br /> 0 <br /> 18.Designated Facility Owner or Operator Certification of receipt of materials covered by the manifest except as noted in Item 17a <br /> Prrnted/Iyped Name Signature Month Day Year <br /> 6-NHM-C-C-11 <br /> 6-GENERATOR'S INITIAL COPY <br />