Laserfiche WebLink
rn <br /> N <br /> Ln _ <br /> � O <br /> Orr <br /> (D <br /> n.•-. e..ta1 Nealltx OeQaM1mgat r <br /> it <br /> 0 � <br /> -2 r1Zt96 HM'aV <br /> O - I :Dtp CVkSf•p8 <br /> U <br /> � -7ueD>foruy wa <br /> rr Form proved.OMB Ho.205"'035 o11R <br /> Numbs^ ebeuD leneiC <br /> ryoncy IxmeePhrme 6,ManlleelTrecklrq^. ll. .^ JJK * <br /> 2.P:ao'I<;I a Eme Res <br /> Please dnl or IYPe.(Farm doslgnnA I„� (ILpilchl typewriter <br /> '.N,;n15,” <br /> UNIFORM HAZARDOUS rr,�.,amis Sde Addrose Ot ma,I,��.11eo�,man,�,.1,.o-n•,,.; <br /> WASTE MANIFEST " yy;;Iikn <br /> 5 GenomWee Nxma nn.l AJ.IAi�i,l nn,e.� i it: I Chli <br /> U.S.EPA ID IJmnbe, <br /> oNl Y <br /> n T.,,, "I" : .N." U.5-EPA 1p IJumon, <br /> V <br /> 7 <br /> U.S.EPA ID Number 1 <br /> B Di•ri!li�.il.,�(�;�Int N.;I;Ii,and:,.le A(In1..': lift <br /> 10 Containers 11.Total 12.Unit 13.Waste Codes J <br /> Fay:J;ly`Ph,,, Name.Hazard CUss.ID Number, 0—bly `A'tAlcl. (\` <br /> 9b.V.S.DOT Descnplu.........ing Proper Smppm9 No Type <br /> 98 and Gm P(d any11 -u)1 <br /> HA1 d Pack <br /> Q (� <br /> W <br /> C 7 <br /> O <br /> Pic <br /> C � <br /> f4 Special Handling Instructions and Additional Information S <br /> yan y rsm n name.ata are Uassifetl.packaged. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:(hereby declare Mat thecontenlse this consignment are full and tlescr.1 D'aove by legut Pt 9 <br /> �+ Exporte-Aadd cen madiabeled)/the conterded nts of lhu consignmenlwnfparconandarennfo oflhe enachedr6PAAcknpowlad9meli lnl of Consend nafional govemmenul regulations.It expos shipment asst am the Primary Year <br /> an Monty Day <br /> ceNtt that the waste minimization statement itlen etl in 40 CFR 262.27(a)if I am a large quantlty Signatuore or(b)llf,I am a small quantity generator)is true. <br /> OU Genensix"V011edi's Phntecirryped Name <br /> Port of entrylexit <br /> O J 16 imemalional Shipments El <br /> Import to U.S El Export rom U.S. Data leaving U.S: <br /> -0 z Transporter slgnature(for exports only): Month Day Year <br /> Cw 17.Transposer Acknowledgment of Receipt of Materials Signature <br /> O Transposer 1 PdnladlTyped Name Year <br /> Monty Day <br /> aSignature <br /> QTransporter 2 Prin(edFryped Name <br /> 18.Discrepancy ❑Residue partial Rejection ❑Foll Rejection <br /> 18a Discrepancy Indication Space DuryanO <br /> Type ❑ <br /> Y Manifest Reference Number. <br /> � U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generalor) <br /> J <br /> Month Day Year <br /> tai Facility's Phone <br /> LO O w 18c.Signature olAltemale Facility for Generator) <br /> O I, a <br /> N z <br /> O N 19!::�� <br /> Hazardous Waste Repos Management Method Codescodes for hazardous waste treatment,dlsposaA and recycling sys ems <br /> 3. <br /> W QU GMonth Day Year <br /> recelDl of hazardous materials covered by the mSi�gnatureexcept as noted in Item tSa <br /> O 1 Pdmedrryped Name <br /> C <br /> � 1 GENERATOR'S INITIAL COPY <br /> C p EPA Form 8700-22(Rev.3-08)Previous editions are obsolete. <br /> T W <br /> O co0 <br /> Cz <br /> � C'co <br /> 0 U <br /> N = <br /> � co n <br />