Laserfiche WebLink
i <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS f Generator ID Number 2 Page 1 of 3 Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST eAL600 r (:3-q- l ga- 313- q;U-11 002260807 F L E <br /> 5 Generators Name and Mailing AddressL Generators Site Address(it different than mailing address) <br /> 4q 6-..Pc Co,• 1 �v .Pommy <br /> S�oelt-1o1� C� 4S?r.S— 1��� /�. S��o7..'•ilc..s Sf <br /> Generators Phone. <br /> ransporter 1Company Name <br /> US EPA ID Number <br /> Ad-.5A 1 -7 d a*,y.:Z 41 T,0 A 15 14 it e000 o7 os y o <br /> 7 Transporter 2 Company Name US EPA ID Number <br /> KIST 4A.1 -1—,-1,ij4' Yn C'A6 qg 3 LI <br /> 8.Designated Facility Name and Site Address US EPA ID Number <br /> e�..tcd., C.N,w ,,, 1 ;7--J :&�— e-d 3—,G <br /> loD'9 ieo4d f-lasLecll <br /> Fagt P�n� I- -70 - - AC (l7 9,70 <br /> 9a. 90.U.S DOT Description(including Proper Shipping Name,Hazard Class.ID Number 10 Containers 11 Total 12.Unit <br /> d any)) 13 Waste Codes <br /> HM and Packing Group( <br /> No Type Quantity Wt:Va. <br /> 1. <br /> iio •r �, Tou <br /> O <br /> u1 <br /> W 2 �A w9g3, I✓t}a- Co�.b�s�;b . <br /> � � ( �t'�iof��� �ts-knl►o�ss /I'�ikJ...t) P(STT" j �M �p Cj <br /> 3. VAJ 10 of We,--.s4G kcrr�o�� 3 PG pool , 3 <br /> X p01 30 <br /> 4 Uill 18Z+4 4Jcs4C- sod. .•• Pyd,vx.-dt Scl,.�.o g v� ; ►2z <br /> Ipo .- <br /> x Pb <br /> 14 Speaal Handling Instructf sand Additronal Informatior <br /> rpt o_ r c.Y 1�,.,..6�- : C✓acus/-o Z 3> ��y a 7 (t ss) c�8(©-1 b37E 6ft4-god <br /> 2) e" 0-0 C1 �ss� rn-I63�� 6r2R-8p( `It/) ti'�� tsLl 6 ,e l o) 0810 -i it GQ2-go3 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping nam.and are classified.packaged, <br /> marked and tabeled/placarded,and are in all respects in proper coed tion for transport according to applicable mtemationai and national govemmentat reguiations.If export shipmem and I am the Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(d t am a large quantity generator)or(b)(if I am a small quantity tor)as true. <br /> nerators ors Print Name gna re , ay ear <br /> zz, !o / a <br /> J 16,Intranational Shipments <br /> F ❑Import t .S- ❑Export from U.S. Port of entry/exit: _ --- <br /> Transporter <br /> --Tra ter signature(fore Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Matenals <br /> � Tran Prirtedlryped m gnatur ay ear <br /> CL �l•`a, <br /> Z Transporter 2 Printedayped Name 81gril Month Day Year <br /> tY <br /> t-- <br /> 18 Discrepancy ff�11 <br /> 18a.Discreoancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection Fuh Rejection <br /> Manifest Reference Number <br /> 18b Alternate Facility(or Generator) US EPA 10 Number <br /> J <br /> 1, <br /> a <br /> LL <br /> Facility's Phone <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N 19 Hazardous Waste Report Management Method Codes p emen <br /> .,codes for hazardous waste treatment-disposal,and recycling systems) <br /> 0 1 2. 3. 4 <br /> 20,Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manrfeu except as noted in Item 18a <br /> PTinledrTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />