Laserfiche WebLink
Pleasep(W or type.(Form designed for use on eft(12-pitch) AWBwM Form Approved.OMS No I 20s^aw <br /> UNIFORM HAZARDOUS 1.Cw*ndor ID Number pap 1 of 3.Emergency Response Phone JOLMOftstTractitingiltarnter <br /> WASMMAWIFEST <br /> T 011386809 FLE <br /> &GSFW"s Name and Mailing Address GeneraWs Site Address(N diftwt then maillint;address) <br /> HE'4R't AkiENUE <br /> GeneraWs Phone: "it ic0-9f--Os L5Ck-)N, LA 953Le-96t i <br /> 6.Transporter I CTnW—y Name U.S.EPA ID Nurnber <br /> 7.Transporter 2 Cmipany Naans U.S.EPA ID Number <br /> Designated Facft Nam and SiteAddress 0. U.S-EPA 10 Number <br /> t <br /> Fadi'Vapiece: <br /> ,*tel' 3 8 kZROZ051-J924 <br /> 98. 9b,U.S,DOT Des*§w(hck*V Proper Shipping Nara,Hazard Claw ID Number, W Codakners 11,TOW 12.Unit <br /> HM -4 PbWV Group(N any)) No, Type Quantity wuw,ttJ <br /> 13.Waste Coda <br /> Z <br /> 3. <br /> Uj <br /> 4, <br /> 14.Special Handing Instructions and)IMitimialWwnalkin <br /> 1 <br /> 10'"t::'., a,31 id Waste (�,A On I y) LoGS#OaCk) <br /> 11 05f,4(Nt,,u x 11,1 NA L ic,,,ti io w t A iI Jf,k <br /> 0 <br /> is. TOR ATION: I hereby declare that to comerits,of this owtsignment are Uy and somwately described above by the Wow shipping name,and are classiflect,pscks*, <br /> marked and labelisdifti6tcarded,and are in all respects in proper condition for transport accordN tD applicable international and nab"governmental regulations.N aqw shipment and I am the Primary <br /> EVOW 100*that the MnWft Of this consignment WftM ID the terms of the attached EPA Acknoviledgment of Consent, <br /> lmty#WUte waste*"wdmstatement identified irtOtt CFR 262,27(a)(fflamalarge i*mbtygwwe* (b)(111amasmaliquantity <br /> ,generator)is We. <br /> GZene M Pnntedi7yW Reim Ngna t f With way Year <br /> OAAAA e r <br /> -i I international Shipments <br /> M uw to U.S, EDExport hJus. Pot of <br /> Tramn—w S�A_n(fa!SZ!abl., Data U.S.: <br /> CC 17,TransporterAcknowledgmerd of Receipt of M"* <br /> TwWorter 1 Prinledirlyped Nam' Mwth Day Yew <br /> "ntnr,.,nv MAf-41, <br /> U) Transporter 2 Pd Name <br /> Month Day Yew <br /> I Ogle). <br /> 188.D- <br /> /pAncy indication Spam 0 Ondty ❑Type Partial Rq..%. F-1 Full Relisch. <br /> Manifest Reference Number <br /> 18b.Abernate Facility(or Generator) <br /> U.S.EPA ID Number <br /> Fed. <br /> 1f Aftemate Faddy(or Month Day Year <br /> 0 <br /> 19.HazardousW"Report Mainegerneird W40W Codes(i.e., for hazardous waste treatment,disposal,and-Y(*V"ems) <br /> LU 2, <br /> 0 13. 1 4. <br /> 2D-0-0%ded Facifily of receipt of hazardous me"cowered by the mwAW except as nDWd in Elam 18a <br /> PmWy*Name -4 <br /> Signature Month Dey <br /> EPA Form$700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE SIF REQUIRED) <br />