Laserfiche WebLink
.. <br /> NON-HAZARDOUS 1 Generator ID Number 2.Page 1 el 3.Emerg=nr I.Waste Tracking Number <br /> ON M <br /> WASTE MANEFE5T � �t4Fi <br /> 5.Generator s Name and Mailing Address Generator s Site Address(1 different than mailing address) :^ <br /> -.¢ <br /> I <i'jn+i":l <br /> 'i'r.,RK1.:C):'3F twtJ i� i`i: [ 1?jr i.'• ( �?;r�" _� <br /> Generator's Phone: <br /> .6.Transporter 1 Company Name U.S.EPA ID Number <br /> I' _ <br /> 7.Tronspouer 2 Company Name <br /> U.S.EPA ID Number <br /> �1. <br /> S.Des gnated Facility Name and Site Address i U.S.EPA IU Number <br /> rcCl fsEL1.; iAi`li,��i'_L riifi b <br /> ' .���;r-' 3�r'_i}fi�Ells�!.�:('iC»• {� oys±: �_ <br /> il; X ; <br /> +I <br /> Facility's Phone: <br /> =- 10.Containers 11.Total 12.Unit <br /> 9.Waste Shipp}ng Name and Description <br /> No.. Type Quantity Wtivol. <br /> ! 1. Ci>,itt t'r.�7f sir rL! >flVAIE;TE t";i_iia 64f)!i. s"t"l ti' <br /> (. 2. r <br /> J, <br /> min <br /> 4. <br /> 3 <br /> j <br /> 1 13.Special Handing Instructions and Adddienat tnformalion <br /> 04 � mow:; <br /> a b r. <br /> 14.GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper stopping name and are'classified,packaged <br /> 1. <br /> marked and labeledlptacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Gane�oeslOfferoes PrinledlTyped Named <br /> Signature �, Month Day Year z,; <br /> � Aq <br /> f " <br /> r 15 Intemagonal Shipments a" y tr <br /> It r-' Emport tkf U S ❑Export Port of enlrylexit:, <br /> `._ Trans orter S nalrue'lar ex rts'onf i. Y a 6 <br /> Date leavi U.S.: <br /> is Transporter Acknowledgment of Re 1pl of Matenals <br /> f� Trartsporter.l Pnnted/iypedName qi Lu <br /> SJgnelura xw ✓ 'c, Month Day Year <br /> Tran orter.2 Pdnted/iyped Name -.-Signature— Month .pay Year' <br /> �� 17 Drsc`epancy., ` .13 <br /> I 17a Dlsaapaney Ind cation Space �' D Fun Ree on <br /> i ❑Quantity ❑Type ` ❑Residue Partial Rejection <br /> i �� Manifest Reference Number. <br /> 176 AlCemate FaCllily(or Generator) U.S.EPA ID Number <br /> f <br /> r <br /> �� Faafity's,Phono `. ` .• <br /> W' i?Cr,%nature of Alternate Facd br Gonerafar <br /> W. 9 Month, Day Year <br /> a <br /> 18 Desr9r�ated Facrl&y:Owrter or Operator,Cerlil catibn'of receipt of materials covered bythe manifest&deptas rioted in Item 1 a `.t <br /> n�te�f Signature onlh Ye <br /> 4.- <br />