Laserfiche WebLink
0 <br /> 22346270 -7,116�� )J Q �j' 1205923 <br /> Please print or e. Form desEgned for use on elite(12- itch)t COR47 kR� c7 31/ / Fop/moored.OMB No,2050-=9 <br /> UNIFORM HAYARDOU8 1•Generator ro Number 2.Page 1 of S.EnmVncV Response PNom stNumber <br /> WASTE MANIFEST CAR 7239 2 87? �-26 [ 000 <br /> 7204 JJK <br /> 5.Generator's Name and Malting Address Gmeraloes ate Address(11 different then matting address) <br /> Hose Depot C/0 PSC Attu. Hose Depot CSO 11011 DEPOT #801916 <br /> 5151 San Felipe HORS DEPOT 1801116 251 COMCB AYE <br /> G TI 77156 (160343-7344 9 <br /> i.Transporter I Company Name U.S.EPA ID Nw dw <br /> 210t COY EUM10N!l MAL HANAGEHM OF NEVADA,LI+C CA MIL64012 <br /> 8. M4 Facey Nemo <br /> and MO Address U.S.EPA ID tAxnbet <br /> 2181 CeuturT Bavirolivental lauge>teut of Nevada, LLC <br /> 2195 lowlands Or. Scat <br /> Fal aPnone:brAleT, NY 89418 (775) 575-1769 NVI)980895338 <br /> ga. Bb.U.S.OOT Description(inft erg Proper SMpping Name.Hazard Class,10 Number. 10.Containers <br /> II.Total 1T.Unit <br /> HM emd Pac*8 GmW(ff an1')) No. Type tauarndiy WtlVol. 13.Warta Codes <br /> 1•1111951 VISIT XROSOLS, PLANNUH 2.1 0a - 8 k(1} 47411) 111 0115 8917 <br /> x <br /> 001 Lw oa SG P <br /> 11 0135 331 <br /> 2 S, ETONS, RE L BYHYL 911 0139 331 <br /> RQ IM99) 3 PSII (FLASOPOINT=21,11c) �RQ(a111=tfo) C)d I � 0037 P <br /> X 3 e e.--8¢(l111i ) 4` 1 <br /> 4.0113266 WWI COMOSIR LIQaIO, BASIC, INO IC, N.O.S. (SODIOR IN2 122 <br /> X HTDROIIDS, POTASSION BT0101106) 8 PGII 8Q(O 2ffi119) QQ ' DF ®®,,q P <br /> 14,SPedal f4aindlIng InsUuc6ona and Addlonal fnlorin� �('`�0 I/e J e g k I <br /> (1) BOSSZ.1-14 - MUMAEROSOLS-ACCQl10LATIO (2) 8 3-11 - 00{128) PLAMBLE LOOBgPAC16 <br /> TBNfi-{LiQO )"�4) BORSBB-15 - 1010450 RKA1I1E/COIROSI9l M0103161: <br /> 15. GENERATOR`$MFFERQR's CERW=T*W.I trareby dedam that go calm s of this crostgnment aro My and aOauatolydes*nbed abim by tfta Proper shO ft Hama,and are dossiffed,packaged, <br /> mocked and fatxWoftarded.and aro In all respects in Proper oorrdmion for barmport accordNg b appOr t interneiorWand naDonai t n prlations It expoA sNpment and I am the Pdmery <br /> Exporter,Ice*Qw1UN!conterde dpnent oonbrm to the terms of the attached EPA M*f Consent. <br /> I certity drat its wash mini ' tWartiffed in 40 CfR 282.27(x)(if I am a large ktusntlty ami gena is bee. <br /> Reneratoraf0iera'sPdaledrfyped Nam Sonatas MoA Day ear <br /> ❑Im to U.S. ❑Export frons U.S. of entry/ext. <br /> Transporter s%naNae Qor exports only): Date ' U.S.: <br /> 17.Tran WetAdmo hdgmsnf of Reoel1 of Metertats <br /> Transporter 1 PdnlWWcJ Name Stnatore Month Day Yen <br /> AN tam .. � '�'� a 3 )Z U <br /> rortsporter 2 l yped Name SignaNrro tonOr Day Year <br /> 18.01 cY <br /> 1as.Discrepancy Indication Spm ❑amity ❑Type ❑Residua ❑PamsdRelection CIFURejention <br /> Manbsl Reference Nunber. <br /> lob.Alternate Fimility(or Generator) U.S.EPA ID Nwnber <br /> FadHVs Phare: <br /> tWmtiii ofNtemaleRadity(or anera Y9ar <br /> 10.Hazardous Wade ReW Management M0W Codes(tor..*odes for hazardous waste trestm K dbposai,and recydIng syateme) <br /> 1. 2. <br /> 8141 0141 3. 1 a I <br /> 20.0esignated arae Owneror Operator Car6ir ton of recelpt of hazardous matstice covered by ire marifW except es anted M Ham fta <br /> yPad me Yew <br /> o �s 1 Iv <br /> EPAFenn@700-22{Rev 3-05)Prevbusedilionsareolreolete. DESIGNATED FAC TY TO DEST)NATION STATE(IF REQUIRED) <br /> t.rs 1tn . 4n—nn%In <br />