c\I
<br /> cy)
<br /> 00
<br /> r- r-
<br /> c')
<br /> LO
<br /> CD
<br /> ry- co
<br /> n
<br /> O
<br /> ly
<br /> rr
<br /> FU-App,lad rPAS Ni,,205
<br /> ,, pno,or biceFoll,ne'-gh.111,use on che -
<br /> (10,11, Vega 1 n' 3 Emerge—R--Peon. A.M11 felt— "
<br /> I hum '
<br /> UNIFORM HAZARDOUS SKS
<br /> WASTE MANIFEST
<br /> eizl'rs p", U S EPA 10 N-~
<br /> U.S EPA 10 Numse,
<br /> It— S'L
<br /> FII I Panne qo U.S. H-110tiss ON-bar i I C.M."er5 11 Total 12 Ur 13 AI Cldes
<br /> and pa,
<br /> ",,4 NLc T_
<br /> 0
<br /> 14 SosCmi HaJl,,g hoMinom,and A461slad Infohnal-
<br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION:I bendy dejare that the contell"ths mosignmem are hAny and amurnalely desolload III by the pr ame.arroi are dassified,lyawgeo
<br /> the'sol and lawed;p",anded,and inem all resumstsm properconsew for,hempor acoondmg h,appi.blemnernso-oilamij national So.momorml
<br /> &we, that contends of Thl;oonsughmem,,mfon to Me terms of Me aftsorma EPA Acknowledgment of Consent.
<br /> ,"I that the nism mirenrossoon staiermol denlifiedo 40 CFR 262 27(a)Id I am a large quantity generator)m lot fit I am a small cloambIty generator)is we
<br /> .."alse.0flem's Pnntsd,7,p.Name "Uhr, D" yoo,
<br /> P-1 16 irtemabonal Sh pmerfs — I I
<br /> tJ J S =1 boon Irom US Pat of sol,em
<br /> Transformer signature('v e.pors nye Dole me'Ing L
<br /> IJ`Transx?
<br /> T—P.-I Prim,d"rysed N8,1- Signature --7-h Day fear
<br /> 0
<br /> uled,-Iy*Name Signature
<br /> Month Day Year
<br /> i 16 D
<br /> 18a Doorso.r.cy norcatum Spa.
<br /> T,,.. Residue ❑Purnal Relti EJ Full Rejection
<br /> Itht All Faclliryfor Generalal MandeSt Reference Numbs,
<br /> U S EPA il)Number
<br /> jai FaUly's Phone
<br /> 1
<br /> I Ific.Signal m0fAfternater"difo,GehsmM,j
<br /> ti
<br /> 19,Hazardous Warns Rloo'.Management Mempd Cedes
<br /> LV w
<br /> 4 6.,sorI for hanrjwahle[met
<br /> ........Ursposal,an,-,,I,n,
<br /> < E r 0-o'gooled FaIlIny Nn,,
<br /> c) 2 "ohmelffoped Name
<br /> 0 �A Forth 8700-22(Rev 3-@E.,p.pyiods edifons are obsolete
<br /> -0
<br /> 0DESIGNATED FACILITY TO GENERATOR
<br /> 0
<br /> L
<br /> 76 >' (Z
<br /> E
<br /> -Fo N -T
<br /> LU
<br /> E 0 0
<br /> 0 00 F--
<br /> 0
<br /> c\I
<br /> cy) LL n
<br />
|