Laserfiche WebLink
Pieriaprint .(Form designed tar use on elite(12-pitch)typewriter.) Form Approved.OMB No.20504)039 <br /> UNIFORMHAZARDOUS 1.Generator ID Number 2.Paye I of l Emergency Response Plane 4.VVftg T N <br /> WASTE MANIFEST 1^A1 „ [L A r� ^ la 13 8 8 FLE <br /> 5.Generators Nan and Ma6ng Address Gulr=Ws Sito Mms(it ddlarentthan Maamg est <br /> Goldit.Sale Lunter <br /> 30:13 R Aipod We <br /> Slocilim CAM <br /> Generators Pme:.7ft-2.U-7700 <br /> 6. ransporter I Campry Name U.S.EPA ID <br /> Sia SWEnvi+a711nadN SaWant CA1.00CUS010 <br /> 7.Transpoaj 2 Conany Nam U.S EPA CD Number <br /> EQ hd11tt1A1 S+MM 41MIK 435 042 742 <br /> Facility Name and Site Addrass U.S.EPA ID Number <br /> US Ecol <br /> I1911WYy 85 12 Ribs South o1 ? <br /> Natty NV=3 <br /> Facil sPhona:773-33,2203 IWVT330010M <br /> ga. 9b.U.S.DDT Desarption(uWudmg Proper Sldppag Name,Hazard Mass,ID Number, 10.Conch refs It.Total 12.Uril 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Duantdy NAA ObL <br /> 1. <br /> NanRCRAHuardaus Vias,Sold 1� �_i� 'I "A 352 <br /> �; S( <br /> 2 <br /> 4 <br /> 3 <br /> 4. <br /> 14.Spoaal Manua Ins7uttionsand Additional Information <br /> V"PPE ERG#171 <br /> Pf#lk# 07012830045181 <br /> EMERGENCY CONTACT JEFF RHODES <br /> 15, GENERAMA VOFFEROR'S CERTIRCATION:I hereoy dedere that the contents ol aria consignment am"and=ratoty described above by da proper shWtg namm and are classdied.puka;d. <br /> marked and labaiedlpL3rarded,and are inas respacts in proper condtion for transW aocan!M to ap0imb*intemaUona!and national gavemmontai roguWdoru.II export slupmtnt and I am era Primary <br /> Exporter,I certify=I tlw contents of this cons$nn:em confam to Na terms 0 the atlactted EPAAckrawtedyment of Consenl. <br /> I cart4 fhat the rvaste mebmizebon statement identified in 40 CFR 262.27(a)(d I am a targe quantby generator)a(b)(If I am a small quantity generalar)is true, <br /> ora c s 1 amo "e J : n y eraz� <br /> 16.ts4rmatianat Sh pments ❑urgo to U S ❑Export hen US. Port at enbyrext <br /> Tra fore Date le"ng U.S.: -- - — <br /> W 17.TramportuAdmorledgmenl of Reneipt o1 MatoWs <br /> Transporter I PrtntaWypad Name re > >� DayMonth year <br /> J *! /:y <br /> Transporter 2 Prvtled7 yW Name 5iGnature uay Year <br /> 1e.Disatwm V <br /> 18a,Discrepancy Indies on Space ❑ cuanoty ❑Type ❑Residue ❑Partial Rep otion ❑Fut Rejection <br /> Manifest Reference Number <br /> 18b.Altenuto facility(or Ceaarato) a t U-S.EPA ID Number <br /> Q <br /> to fadIri Ptarre: <br /> t6c.Signanua Arxmate Fwhty a Oar) Moms Day Year <br /> - <br /> th 19.Hazardous Waste Report Managemant Malhod Codes(i.e.,codes for hazardous waste treatmonl,disposal,and recycling systems) <br /> O1. 2. 3. 4. <br /> 20.Desigretod FaD of Owner or Operuior.Certification of receipt et hazardous materials csvered by to man%g except as re td m Item 183 <br /> ArdeVyped Name n=re Moft DayYear <br /> EPA Form 87D0.22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />