Laserfiche WebLink
rre�se pant or (Form designed for use on ekte 1 <br /> ty ewdter. <br /> r <br /> UNIFORM HAZARDOUS f.Generator ID Number Form roved. <br /> WASTE MANIFEST 2 Page 1 of 3.Emergencyr Response Phone 4.Manifest Trackf Humtret <br /> g •�f <br /> 5.Genere�r's Name and Magng Address f S:rid"k'r G ri <br /> Genet <br /> �•_ rals SBe Address(tiPedlfferent than marling address) _t° <br /> ly.t_'.1.6C e i.44 C�"`u`�i.,t�,sdlii i <br /> s, GTr�; KTr3N,GA 96ZM <br /> CA <br /> Generator's Pbone: <br /> 6.Transport¢ 1'Company Name <br /> 02,orge AAs U ,trio. 1111MALU.S.EPA w Number <br /> 7.Transporter2Company Name RX: Cfif°!?CrA7+�49 <br /> �-�' U.S.EPA ID Number" <br /> 2 ;~ 16c"`CI E.�#3111[}ffi�LR . . U:S.EPA lD Nwnbar <br /> ' .. F sPhonei •��"- . .... ,. ENVIRONMENT/-tiL <br /> {axfurFng Der RTMENT <br /> sa. �us.tion ...._.-. - - . <br /> "Ping Name I, z M Cla N Number .. <br /> - ` <br /> HM <br /> mrd Nadd�t;ro (deny)) 10•Containers. <br /> h �b�ttafiemi No: 1t.Total 12Unit <br /> Type Quantity y13. <br /> asto Code <br /> s' RR 1 �2�J' vtvof.tiaoil¢ <br /> nzt 2. # <br /> t9 t <br /> 3 <br /> 4. <br /> 14:Special s azWAdoT0ona1 fnfarrnatfen <br /> 15. GENERATORS/01FERtHY3 CERt1FICATtON:! <br /> marked aor!I et and are In all bereby declare that the co dents of flits ixnreignoant are fufiy and abet <br /> Exporter,I certify Brat the contents of this con i in proper condition for transport accoiderg b ttcabla Iniemetlona!and a ve by the Proper sfdppfng name,and are classified,packaged, <br /> slgnment conform to the terms of the attached EPA national govern talregu�6ons,Jf export shipment ayd!am the Primary <br /> I wase mkamaatlan statement IdentRed in 40 CFR 262.27(aj(if t am a lenge quarttiiy general or Conserd. <br /> Gern rator slOBerors PnntedrNa r trt i S. f fdt am a snag quaintly generahx j is We. <br /> y� ( orj (b <br /> 16.International S s" { i t, ( ` \. A�Pon<h Day Year <br /> f�rtenn hipmertts � fTnn ' +}C....,,,� �;• . p,.�.vr.--''L� [[/y� <br /> Z T e"PO�4natwe(�exports t•t'ry(t to U.S. �.J Ex `�t S. Port Of <br /> T t 1 <br /> 17.TransporterACIMMedPen(of Receipt of Materials Date Ing U.S.: <br /> T 'per �g <br /> 4 racepq�gtarF i_.�L�J <br /> Tiansporter2Pr�ted/1yYPedPtame Manfh Day Year, <br /> rr <br /> %7%"QR rre <br /> f8.olscrepency <br /> Day Y <br /> 188.Discrepancy tndipUoe Space z <br /> ❑ Quantity ❑Type - LJResidue <br /> ❑Partial Rejectlon ❑Full Rejection <br /> 18tl.Alternate Facey(or Generator) Manifest Reference Number: <br /> a U.S.EPA 10 Plumber <br /> C Fackty`s tine: <br /> 18C Signature ofAhemate Facility(or Generator) <br /> i • <br /> Month Day Year <br /> 1g. <br /> Han rdous.W�e Raport piynagement Methal Codes G•e,. � hazardous waste treatment,disposal,and11 11 <br /> 1. ) �0 Z al sYs►emsj <br /> j { 3. 4. <br /> 20.Designated Factllly owner or Operator Certlfica6on of receipt of hazardous meiterWWs covered by the manifest except as noted In Item fag, <br /> rho )ped Na <br /> t — <br /> • Month Da' Year <br /> f=orm 8700-22(Rev.3.05 P � `� <br /> revfars edi ns ate obsolete• �^-••----._.- _., � ; <br /> �,s^ .. <br /> �' `-- TRANSPORTER'S COPY <br />