COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

PI ase print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050 0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manures Tracking Number a �-0�'01 08 0 51CI 476-1740 WASJJ K TE MANIFEST -f e_ 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) Stec,,ihis:41`iF'a It i,+a6t+,E t•farni'ner L. *i :1A, Generator's Phone: r1?`aye" r U.S.EPA ID Number 6.Transporter 1 Company Name9 ! E:tr.V.;t•l_ilkiiit_A?-'t I:;?a'ta 9iA�nt'ti�:� tDN bar U.S.EPA ID Number 7.Transporter 2 Company Name 8.Designated Facility Name and Site Address U.S.EPA ID Number }s'8: ?aPr�n i t5?!_§�4i.:t01:6 F."k2 �ssvot e f:A tt`_620 Facility's Phone: �Gr-t==p*-fit?� 9a 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WtJVoI. a C T °� �t cr �E /: O z 2. 3. QjQ F !'p trr•,.rl, :i`. I Ia, III toil i•t,. ( !Lt .'r.�� d i 4. i ` u 14.Special Handling Instructions and Additional Information / tom.<':�t'Yk�t::S f*tz_ . _;F;t�'2��E:te+;F,.:t�.�6'itac'6:t,.d.,;,r-ds_. .�Lrrti.•1(. i1'T�1. C 15. GENERATOR SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and latieledlpiacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 46 CFR 262.27(a)(if I am a large quantity generator)or(b)(ff I am a small quantity generator)is true. Signature Month Day Year Generatoesl0fferoes Printedtt ed Name ,q f .j 16.International Shipments ❑import to U.S. ❑Export from U.S. V Port of entrylexit: z Transporter signature(for exports only): Date leaving U.S.: IX W 17.TransporterAcknowledgment of Receipt of Materials Signature' Month Day , Year � Transporter 1 Priritted(fyped Name b �, } f. W L , fir ) Signature Month Day Year za Transporter 2 PrintedfTyped Name ccH 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. U.S.EPA ID Number 18b.Alternate Facility(or Generator) J V Facility's Phone: Month Day Year W 1Be.Signature of Alternate Facility(or Generator) a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) wo 1 2. 3. 4. cf 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Year Printed/Typed Name ,. Signature f, l i EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. - DESIGNATED FACILITY TO GENERATOR