Laserfiche WebLink
r, <br /> I � <br /> Presse print or type.(Form designed for use on elite(12- Rch)lypeyrtiter.) Farm Approved.OMB No.2050-0039 <br /> UNIFORMHAZARDOUS 1.Generator lD Number 2.Page l of 3.Emergency Response Phone 4.Menlfest Tracking Number <br /> WASTE MANIFEST ry . Q 3-,t] 3 3 ;g7?1 �??-91j�� 000 0 3 9 8 4 5 DAT <br /> , 5 I5.Generators Name and MailingAddreas - Generatorsariana(If different tan mailing address) <br /> r <br /> SRI# 211W-19, tliUNT SAI) 1".-^91119 EPPOU <br /> SROU OIRPOAT UAY 5093 3IRPORT VAY <br /> Generators Phone' `O" `7 i`RqF705 {:5.0,y6.5414t2^ `Altpwerr'' CP 9 2 11 )4591 Y <br /> fi.Trebaponer l Company Name - ] U.S.FIAIONumber <br /> T+i,•' = vir Yt -, ''ar ' - 3 formia LP CARgQ <br /> 0210617 <br /> 7:Transpoeer2 Company Noma - - U.S.EPA ID Number <br /> e.Designated Foally,Name and Site Address U.S.EPA ID Number <br /> 241FUMM.1 E1d`J1R0,'L jJH 1< To7,f <br /> 1U2'S ;'T3 RVERE sOfI7 <br /> FacPoHs Pisms:KBIT, VII RON.. 2571 .5'- .. 'r)RFl9tS1.251757 <br /> 9a. 9b,U.S.DOT Description(Including Pm;uarS'h:m,-g Name,Hazard Gass,ID Number, 10.Containers 11.714e1 .12 Unit 13.Warm Codes <br /> HM and Packing Group(Iferry)) No. - Typo Quantity VAMI. <br /> P�� <br /> D19 r3 I <br /> u OFzSZ FD`t! "_. :="iPL' 3 F:II VIT-51i 1161; Ee jj[d <br /> A <br /> 3 pOQJ � <br /> u,. .._. ._.. _.. eauue_mroa_s..,....., <br /> r r.- nrnn nanelld rT-1 1 ARTY Op _ <br /> { <br /> I <br /> 1I0 I%JD.S; fLAI{ AALE,. ARAF1r'sC, R.O.S. (➢IAZmkt, <br /> Z:, UISTELRTES) G,1 13) P61I ROIR¢=11212a�1� -� <br /> 14.a e: t q InshallonsandAddifionalklannallm - - <br /> _ " EtZ6(M LOtl//5EP0^K CiL ASE F Mq MUUM UO EM11U1 LOOSEPACK OIL ME P r3i zz"-��—`� <br /> `-! let MOMI-9-1.� - EA01133l) LAWN- PESTM NS, <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of Nis wnsignnentere hdtyand accuratelydesrnted above by the Proper shipping name,and are classified,packaged. <br /> marked and labeledfploamed,and are in all respactsin proper condition for transport arcnmmg to appllwbklntemationaland national governmental reguiatims.If axpod shipment and.(am the Pdmary <br /> Expodet I cerbir that Me contents of this consignment confirm to the terms of the attached EPAAcknowledgmentof Consent. <br /> I carlGylhat the waste inhai®dun statementideng8led in 40 CFR 26227(a)(if I am a large quantity generator)or a small quanty generator)is We. <br /> Genaratorsl0gemrs PdnladlTyped Name - blimallifit Month Day Year <br /> —s 16.International Shipments <br /> F ❑Import to U.S. ❑Evpodfrom U.S Partatenay/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TranspoderAcknoMedimentofReceptor Materials <br /> Tran '1 PdntWffypa Sig re Mont .Day Year <br /> Transporter 2 Pdntedflyped Name - Sign Ment D Year i <br /> PM <br /> 18.Discrepancy <br /> i6a.Discrepancy Indication Space. ❑ On,* El Type ❑Residue El Partial Reteckin ❑Full Retention <br /> Manifest Refarenw Number: <br /> 18b.Alternate Facility for Generator) U.S.EPAID Number <br /> V <br /> ua_ Facik'P/s Phone: <br /> G 18nSignature ctAgemate Fealty for Generator) Month Day Year <br /> y19,Homrdous Waste Report Management Method Codes(I.a.,cedes for hazardous waste treatment,disposal,and recycling systems) <br /> 4. <br /> 20.Designated Facility Owner or Operator.CaNfcalion of recelptof hetardous nationals covered by the manifest except as octad In Item 18a <br /> Protect I year)Name Sgnalure Month Day Year <br /> EPAForm 8700-22.(Rev.3-05) Previous editions are obsolete. LSESIGNA7ED FACILITY s0 GEVINA1TIr'JN STP7g c(IF R-f2uIF w) <br />