Laserfiche WebLink
29222 3b <br /> rre3 for use c n eSite(12-pitch) writer t <br /> Please printer type.(Form desig ( P typewriter) tl Form Approved.OMB No.2050.0033 <br /> UNIFORM HAZARDOUS 1.Generator 0 Number 7..Page 1 ofi 3.EmCrgc Icy Rcsponsc Phone t.Manlfask((T�rackia Number <br /> WASTE MANIFEST CRL€ltt=El3 L17 f {S r 3 X77—?FiFt�l � J 3177 DAT <br /> 5.C,er*raws slams and i;5,ing Adcfrass Generator s SiteAddrass[rtdltrerentthan rrailingaddress) <br /> III& LATS 5TORES Ks LATS 0417 <br /> 388 pF:I up 0 ATTN: BER FEW 1321 1Esf YOSIIi111 AVER"k <br /> Com.-rrerarorsPt�ar>o: C(3i.1Jlt�EES QI< 432$ {€�I�€21$-4&34 IiAfi7E�fi Cfi X5337 <br /> 6.Transporter t rornpany Name tF.S.EPA J0 Namber <br /> STERICYCLE SPECIR€-1 Y UPSTE SIDLU;I€NS INC ! €S tlQilflEt24 <br /> 7.TransPa'ter2 Company ttiame U.S.EPA0 Number <br /> a.Designated facility Name and U.S.EPA JD Number <br /> I15T CE#fM ENVIN( f£Tt?'AL fflMffalfi OF NEVVI ilf, (I_C <br /> �A9� Il�fili}AdS �E'IYE East <br /> FacittYsPhone:FERIILEY, XV $4489 1175) 515-2750 hil�I} 8E1B95338 <br /> 3a. 8a.U.S.DOT Desuiom{irrdWtg PmprlrShipfttng Name,Harard class.ID Number, 10.contt3iners <br /> Him and Packing Group(f anvy, Qu WI Total Unit {3.Waste Codes <br /> No, Quantity .1Voi. <br /> T <br /> R' <br /> I <br /> �z 2. <br /> Uj <br /> , . <br /> " , - B P <br /> 3. <br /> a. *1933 WSTE fl(MILE LIWIBS, Il.03- II(EROSENE, NEW 3 PS1I � � 331 ;Is <br /> lots <br /> IC RQi�l=td3) P <br /> 3097IIE3S <br /> 1<_SpwW Hwdfrrg k*kudnns and Adrd*at Int erratiorr <br /> €I) PUIERDS1 943 - E961120 AEROSMS (2) ILCON I143 - EM ISA) MIMI` SUROSFYE LIU (3) 3LIf MISIC-83 - E1t6(I54) <br /> IPSIC CORROSIVE LIQU €S) ILFLWLIQ-23 - HUM) FLfiWU LIQUIDS <br /> 15. GFfIERIc71ffw FFERm s GEitrwrA:Tm: I herebydedana riat the caHarots of oris cor>sigrnnerrt are fatly and accurately described abm by the pmW ship wg name.and are dassifred,pa&a*. <br /> ma4W and marded.and am in aR resperds in pmpescond bon for Wrisport accordarg to a0kable lnternytierratand aMmilal govemmental regulations_tf etgoort shipment and I am ttre Primary <br /> Eaporlar,f oert+Hihait the=&,rft of Itis oorrs nn o mfmm to the tri;ut d,e attirow aP4 A*owedgrWt of CQrrscrrt. <br /> I <br /> w* the w3W nfmWWion sWernent idetai8ed in 4D GFR 28227(a)(f I am a laW 9uarrRy 9—raior (b)(if I am a smatt gaanmy-9inwakid is hue. p <br /> t,eurerafr �Pr:dedrryped Name Ala+xn i Yeart&,int herraaattional Shipment 1_11mpoRln U.S. <br /> Expaihom U.S. Part afen4yle)cil: <br /> Transpostar siSiknSlra(for Voft c6yl: Date leaving U.S.: ` <br /> W 17.TianspoftAdirorvfedgmwtof RoceV of Makaria* <br /> T 1 S& Morrttr Day Year <br /> 03 r z Q7sepop- Na <br /> /re2 5rgnaturo Day Year <br /> 18. <br /> rwyr <br /> 18x,D,=rnpancy Indiratiprr Space El QuamiiY Type Residue El Partial Ref. ❑Futf Rejc�t otr <br /> Manifest Reference Number. <br /> fAb.WtemateFarifty{or GereratorJ U.S.EPAIDNumber <br /> Faeditys Phone: <br /> w iBc,S'rgnatus�ofARerrrataFap7ity{urGerteralorJ Month Oay Year <br /> z <br /> 12.Hazardous 1Yaste Rem MaEagome WdWd-d Godes(Le.codes furhaxardaus waste treatment,disposal.and raeyeft systems) <br /> LLJ <br /> 1. Z 3. n <br /> W.Designated fadi<y Owner or DAara3a ecwflcegon of romipt of hazerdcus matat6ats covered by the manifest except as adad in hem 18e <br /> PrintccYTyp6d game <br /> signature Month Day Year <br /> I ID <br /> EPA FormB 22(Rev.3 G5) Prsvouseditions arect6soiete. DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED) <br />