Laserfiche WebLink
rL, �� els , �Mti905754 III 41 i[ �i1IIIoil III <br /> 0D6aa62503KS <br /> type.( 4 ( )tY4 ) For,n Aap€oved.DMB No.205400:19 <br /> =lease print or Fxrn deli sed for use on elite 12 tch ef. r� 4.Maelfest Trac�kWm Nuum+b& SKS __e <br /> UNIFORM HAZARDOU5 ,.Generator ID Number 2.Page 1 of 1 3eit�/� ?� n V 6 L 8 6 2 5 0 S K V <br /> WASTE MANfFEST ��, 3�g63 V <br /> Ge <br /> 5.Gene'atoft Name and MairgAdd€ess nerator s SileAddress(if different fan matiing addresS) <br /> D 1-;R .in,c. <br /> 3$T wwY CA4a3 ' fjoP <br /> Generators Phone.41 n U.S.EPA iD Number <br /> ` yld�1'SN"13T ` Mr 37tR��t�I�f4�;. F7�J <br /> U.S.EPA 10 Number <br /> 7.Trernperier 2 Company Name * <br /> . :FAN ! PRIBORS �:��t IRCHIENTPd- w4C 1.N., <br /> U.B.EPA ID Number <br /> 8.Desigrralad FaciMy Nanta and Site Address }`fig j }IA RP R.Sa fir= I.v t LM 1 NGT 1P! . <br /> ft <br /> Far�ityis Ptli <br /> ga 9b.V.S.D07 DesaipW f4rduding Proper Shipoing Name,Hazard Dass.la Number, ie.Cortlair ii.TGW 12.Unit 13.Aaste codes <br /> HM aw padkkq Group(f anY)) ..._.,, (.—— <br /> No. Type <br /> .w <br /> Oua <br /> LLA <br /> � 1 <br /> 14.Spacial Hanning ire'-actions and Addii,arai Inforrnrailon T.SD R W x <br /> ae} c's r5 1:.,41F �.,.'T:/{���" $1"-468`".L 6.Ei .S_1 , r. `- C' AS mE ' <br /> 15. GFl�IL4TOR SlOFFERaR'&CERTIFICJITiON: I hereby declare that the coni of[his consignment are fuiiy and aauratety descied above by the paper shtppmg name,and are olassi8ed,aackaged, <br /> marked and Iabaledlpacarded,and are in At respects In proper rbndli on tar transport accornirr to appVioabie ulternaU6natand national 9avammarral rregulaeons.If Rxpert srapment and I am the Primary <br /> Exporter.I certify that the conlenh of this consignment conform to die tents of the attad.ed EPAAc rmIedgment of Consent <br /> I rartify that tt'e waste rrinmt rafnn satemBnl ide ffed in 40 CFR 262.2711 am a"a quantity gereratar)or(b)trfl am as22 11 quantity generator)is hue <br /> IT <br /> J <br /> fsA7lierci Printed'T9rd Name z <br /> GOTSign Day YYewj! � s7 17 <br /> 1 '0 PA <br /> r46.International Shipments Impart U.S. Ll Export f om U.S. of endplextl: _ — <br /> R' Transporter signature',for exports onfy): Date leaving U.S <br /> W 17.TrensparterAcknowledgtrentvf Receiplaf Materials <br /> 1; TrarerpoMer 1 Pnntadll Name Signaturea. ttcntfl Dar Year <br /> 017 117 <br /> jr <br /> 2' T:an 2 PnntedlTyped Nama S goer Month Day Year <br /> Ie.Discrepar:ry II��II <br /> 18a.Discrepancy I M cation Specs ❑ Quanldy ❑Tyne ❑Residua ❑Pa ticl ftz roc L 1 Ful RelecSon <br /> Manifest Reference Number. <br /> 18b.Aflemate Pablity(a Generalor) U.S.EPA ID Nunher <br /> C? <br /> LL: Facilltys Prase: <br /> Lai ?8c.Surae of Alternate Facility(or Generator) tvkk Fh Day rear <br /> a; <br /> v <br /> � 19.Hazardous Waste Repot Manageni Method codes(I e.,codes for hazardous waste treatment.Caporal•and reeyc N sys'errs) <br /> Cr 1' l 2. 3. 4. <br /> 20.Designated Facilty Owner or Operator.Cardfication of recut of haza.'dous materials cove ed by the manfsst ezoept as rated n Item 132 Month PdTay Year <br /> nteb'Fyped Nama Signeh.re <br /> EPN Form 87DO-22(Rev.3-05) Previoui areobsialke. DESIGNATED FAVAITYTO DEST1 NATION STATE(IF REQUIRED) <br />