Laserfiche WebLink
Please print or type. (Form deskjned for use on eft (12 -pita) • ) <br />Form AWMVW. OMB No. 2050-0039 <br />EPA Form 87th -32 305) Prev,editions l a. <br />a GENERATOR'S INITIAL COPY <br />) <br />3. ID <br />UNIFORM HAZARDOUS 1. <br />2 Page 1 of <br />3: Ptwxw' <br />a _ <br />4. Tracking Number <br />FLE <br />WASTE IFEST <br />5. Generates s Name arxfMelling Address GermraWs Site Address PB fferent then roaft address) <br />-qft E f'REMONT ST DAVE OR DAVIS <br />.` B fJ(1I T, TON CIA 19521 <br />GeneraWs Phone:N#19 <br />U.S. EPA 10 NumberI <br />ca€ int'" ;A $ a XRIN11270 :0 t <br />7. Transporter 2 Company Name U.S. EPA D Number <br />8. Designated Fatty Name este! Site Address fl $• —91 EE: k* $ }(;, t} 5 'A�ID Number <br />bNO,r <br />Facis Puna: <br />ga <br />9b. U.S. DOT Description (including ProWShipioing Name. Hazard (lass. ID Number, <br />10. <br />11. Toth <br />12. Unit <br />13. Wasto Codes <br />No. <br />Type <br />HMI <br />and Paddng Group (d any)) <br />Quantity <br />WLAfd. <br />1. <br />W-14 W -NO, _VAIAROWS <br />L0 <br />£3 <br />i4' , <br />0 <br />ETHYLENE SL 't° •OL SOLUlf ION :)..F5S ' 4FI <br />2 pd�` st J <br />J <br />3. <br />4. <br />14. Special Handling Irstructions and Additional IrdionnatiDn#� q�.�„� g y r� �+ <br />P, a^sA.'$°'°T'. a� := ..... s.,. Sia+�.a €<8 ::r� �%f tas,'::1T�a a. <br />. ,g <br />$'.4gg ��,,gr��55 gg-� pp�p j�. �, ��``.' ^fir; <br />�^ <br />i' R r:, R 'a�" '.,. j'�"'.i in;al�"tFET KL t-A,aPx "' 9 8w: f <br />"'T <br />�; <br />15. GENERATOR119ffEROR'S TION: i hereby dad= that the cordents of this consignment are fully and accurately desaftdabove by the proper shipping name, and are classified, packaged, <br />marked arm ' and are in all 'respects in properto applicable internaMW and national gorvernmenfal If export and i am the Primary <br />Exporter, i cartily that the c of this consignment corftm to the turns of the alldW EFAAclutowledgment of Consent <br />I oertify that the waste minimlimlion `identified in 40 CFR 26227(a) (d I am large quantity 9enerato o (b) (di am a small is Iran. <br />GmmWsQWWs . Year <br />18. International Sly❑ krgmrl to U.S. a Export from U.3: Port of enWexit <br />z <br />Transporter signature for Date leaft U.S.: <br />W <br />17. Transporter . <br />Tranw ter 1 PrshteWlfyped Signature Month Day Year <br />O <br />g 7 <br />Q <br />Transporler 2 WmiedRyped Names Signaturea _ y Year <br />F- <br />18. Discrepatay <br />tt��FF <br />18a.. Discrepancy ElQuantity❑ Type ❑ ' ❑ Parties t_1 Fri Remeron <br />Mar" Reference Number: <br />18b. Alternate Facilly (or Generator) U.S. EPR ID Number <br />U <br />FaciWs Phone: <br />w <br />18C. Signature of Alternate Facility (or ) Month Day Year <br />Q <br />Z <br />t7 <br />19. Hazardous Waste Report Management Method Codes (.e., codes waste treatment disposal, and recycling systems) <br />L i., <br />2 <br />13* <br />4. <br />20. Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the ' except as noted in flem 18a <br />Panto Typed Name Signature Mordh Day Year <br />EPA Form 87th -32 305) Prev,editions l a. <br />a GENERATOR'S INITIAL COPY <br />) <br />