Laserfiche WebLink
ilesse pdnt or W. I Form desioned for use on elite (12-NfcWmffwflw-1 <br />Fi3rm ADDwad- OMB No. 2051141M <br />I=PA Form 87CO-22 (Rev. 3-05} Prev,oin editions are obsolete. GEN ERATOWS INITIAL COPY <br />UNIFORM HAZARDOUS 1 1. Generopr io NWr4Xr <br />zPage ld <br />&Ernerclerx-yRasponsaftm <br />MWOM Tw" Nwvnha <br />WASW UMIFEST1,,; - <br />I <br />II .; 1 "r ",1 <br />ME= <br />an FLE- <br />5.OrwaWsN&%andM-iifg AGeneralon Ste M;Z7431M Dun rig MOM) <br />A <br />:tl <br />GanaraWs Fhorw-- f,it. <br />0. Trapspartsr 1 Company Wa—me <br />U.S. EPA ID Nxiw <br />l'• '1S:, . .4 F.- -"V. <br />1K, I.: --: - - ! - - ".. t <br />7. Transp3rler 2 CaWy Nam <br />US. EPA 10 Wffbw <br />8. Designa%d Facility Name and $1e Addm95j-F. <br />US.EFA'DNurA*r <br />8a <br />9b. U.S. DOT Uascrip(ian (irickdrig PrDW Shipping Name, Hazard CLPP5, ID Nwkw, <br />I C.- comin" <br />11. TOW <br />12. UrA <br />1jM <br />wd Fadihg (3*4 (Cany)) <br />Quan4 <br />WAY. <br />13. Wa* Codes <br />No. <br />Typo <br />'c <br />3. <br />4. <br />iS. GENERATORWOFFEROR'SCIERTMATM: I hmby 4edare *at the oord" of #14 =%5iqnnrvr4 ariL killy ard a-watily desated aboye by k pw st)polg w1e. ind we cla"W. PKI09ed. <br />medal and IabaIe&pWxftd, and are in all rsspaos in wow condition kif transport awarling W national gave nmmWregWaCcn5. If Lxpon sNpme" W4 ram the Primary <br />Expo4er, I carbly that M wrAeret of this cwg"nl oonbmn loft leans of tto MWW EPAAckWM&*r&d d 0MAfint. <br />Ica* khal the was* mIrinrhkn Mffey dftiAed in 40 CFR 29227(a} V I am a large quar#4 g&wAx] or (b) {If I am a unall cIumbily gwerglor) is. IPA. <br />CAneraI2f1X)ffwY9 PripbadTypad?farre - <br />MW DaI—TW,-- <br />L <br />-j <br />1.- <br />16. Inbarnaliwal ShipmBrits <br />0 Irfs7Gt b U.S. <br />hang porteraigIrature exporjs onDa% taviN U.S.: <br />17. TfaAWW A*w6*xf(of Fteopi d Mabiads <br />cr <br />nspoftr I YIWNaSignoure <br />-- ft <br />vy ger <br />4 <br />z <br />I rurVorw 2 FMrod'Ty* Nww S"Ble <br />an Day Yfiar <br />iIL Discreparcy <br />iI <br />10*. D'ra�re uwy lndimfi�n Spam El o,;anuty ENP, El Residua <br />❑ Partial MEcdcn <br />❑ Full Rq*;lian <br />Madiw. ftferevioe NumW, <br />lab. Ampule Faciity(or G&waw) <br />U.S. EPA 10 Njwbw <br />.,X <br />1`361JEfs PhDne: <br />isc. signature orAbrnaio ndity?orGsterAx) <br />kimb Day Year <br />14.I lazarouslYaste Rep3d WragerrAnBALAbd Cc&s Cie.. o3dostrhazapdauswaribe hwbnW, EfWmd.ard reqcIng!rys4nnQ <br />3. <br />4. <br />X Ocsigrawl Faolify Npe.,or Operator. CeibficW.ion of receip.01 handous Mterials cMrWl5y ll*r0&niWl;ex0W asnoled h item 16a <br />AW4'TyW Name <br />NjWh My Year <br />I=PA Form 87CO-22 (Rev. 3-05} Prev,oin editions are obsolete. GEN ERATOWS INITIAL COPY <br />