Laserfiche WebLink
192250 <br /> Please print or type?(Form tlesignatl torose on elite(12-pilch)typemReF) .4/1�L t{ SlU('� `—' Form Approved.OMB Na 2050-0039 <br /> UNIFORMHAZARDOUS 1.GenemollDNumrm 2.Pageld B.Emergency Response Fbooe 14.Manifest Tradhg Number <br /> WASTE MANIFEST 41aL17t7U7]7754U I,k_71I 5 1?-2fj 00 0 18 4 8 6 8 DAT <br /> 5.Gr.mra Name and Mall Address Genembrs Site Addmss(a mram t Nan mulling address) <br /> COR-Way FREIGHT tCUFUST XPO Le31S3t3CS FTe196t_, inC, <br /> 5475 S. AIRPORT WRY 3415 S. AIRPORT WAY <br /> Generemrs Pbana. SIIn 5 ! 9) 5 T Ismfi.irarapoder 1 CwnPany Name US EPA Drummer <br /> STERICYC - S)'Fr t TY N. CTE SO' UT'IONS IN 19N5(1nni.,a924 <br /> 7.Transponm2Company Name 01 US.EPA ID Number <br /> 8.Deegrated FmAi,Name and Site Addreme US.EPA ID Number <br /> 21ST CENTURY ENVIRWIERTAL ft WGE)SERT OF NEVADA, LLC <br /> 2495 ReNlands Drive Ea32 <br /> Fear 'a Phone: F <br /> 9,. me US.DOT DescnPBon Induce,Roper SM1iMin9 Name named!Case,ID Number, 10.Conamem 11.Tube 12.Unk 13,Wada Catles <br /> HM and Proem,Group(R mr,d) No. Type OuarNy WWa. <br /> s 1- AMA WASTE SOOIIRI HYDROXIDE SOLUTION 8 PGII ROTD112=1481`! DR42 122 <br /> X I D.N P <br /> 2 Oi142{ WASTE SO41UN NYOROXIjE SOLUTION R PGII RO(3812=1161) f W042 122 <br /> X DN Z1 P <br /> a. 011253 WASTE PAINT RELATED IWTERI9L 3 PG3I ROMBIJ 214 log] <br /> % //1 DMP <br /> 14.Spedal Hzntllirg Imm,dve and AilSriarel InNnnagm <br /> TO CMYWI-RI - EM1541 12112MM211#SI9S SOD 12) COMVNY40I-87 - ERG11541 120741792805IRS SOD 13) CVF12630-12 - <br /> ERS4#711 l2R231l111141I91 LOO <br /> 18. 6FIffRArOMBIDFFEROR9 DERRFIG1pN: Ibnreby dechmtlet Ne wmsmcdNs vwdgnmanlam mIN antlacamb:N tleu hea above M Na pmparsbGPNB vane,ab areclauifiM,Padmg�. <br /> madretlard hbesNp�Ned.aM die in ellrespedsin gapwwntlNanNtrangMacrordrg kappllrsbk'mlemaeorelam natiorulgwe��menlalr�ulafions.Ifeeparlsbipaentandlamtlre Primary <br /> Eywder, ceitaNaatra"Coble aluemrapnneuadl mQ stye sora INfI atlamW ammety I„^wleelar) dCareen[ <br /> IcertiIYNd Newass mmnnWOan sbsmwtl gendfetl n 44 CFR 28217@)(RI dna sgequmdrygmmmlor)"d IRI am a wrell9uantiry genemmrl¢Wee <br /> rx7ePdmetlR N i Ma//,M, 0, Year <br /> V <br /> .15Amematlmdl Sd'pmenLs <br /> 2 ImlwdtoU S. ❑6pwfbwnUa. amof entryl. <br /> S <br /> Su <br /> ^ rr&r3P�ariRrralure llareNm4anIY1: Gare 'rq 5.: <br /> w 11.TrngYwkrAsknuN¢]9memdRareiplafMasMs <br /> OT sP°ds!1;pYPetl !re Sgnature Mo+nN^ De y <br /> a !A1 L V 1 <br /> Qlarrobrsr 2PNaNTypea ane Slgreture MOMb Oa, Year <br /> } 1B.Dsurtpenry ".. <br /> 18m DionpanrylMieebou Surma ❑ Quantity ❑Type ❑New. ❑Parral Raja ern ❑Full Rejection <br /> 18b.NRwasfadlRy la Genemkr) ManResl Referenw Number. <br /> J US,EPA IO Number <br /> U <br /> rQi Fd AiVe Fi me: <br /> w 18c.SigneWmolARemes Facility @r Genemtw) <br /> F Monty DaY Year <br /> 6 <br /> Z <br /> y19.HazaMWS Wass Repod Management Metlwtl Codee(ie.,wtles srberaNws wasteheehMnt,dapaael,ane rerycling systems) <br /> <. <br /> 120.Oa6grasdFadlyOmararOpemiorCekfiwti dreceplofbazmemmnumerals overedbytleTan9srme'aWasroad!inlamlie <br /> PdntabnName Signamm Monty Day Year <br /> A/11ypetl <br /> -f L' 1 <br /> PA <br /> EForm 8700-22(Rev 3-05) Previous editions are obsWele. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />