Laserfiche WebLink
rise sNt9te 1 _ <br /> se¢fmit3Y / 0l�td 2 Pa 1 Dr 3.Emerges-cy orse?tloae 4 ManifestTracking Nlanbet <br /> 1.GenetaiculfJ^lunrber -a012177674 JJC <br /> UNIFORM lfiAU1Rt1Qd1S. _ <br /> WASiE MANIFESTt dfl(7 �.: `I - <br /> _ Q Gerle2;nr's Site p.ddress£if difrerern ttan mailir.^addressr <br /> 5.Gener�tur•s id�a X Pv�llY4.t k(. �N I a—, r <br /> Gene-ator's Plane: -7 d U.S EPA ID Numb,: <br /> 6;Transuort,r 1,Company N2f le <br /> tallsr IAIIVj <br /> 7.1,aj spode U.S.EPA iD Num.;,,r <br /> d Designated Fac:u'ty;varve and Stte.Address�J_.w r � p,1��� � e��-� U.S.EPA ID Number <br /> �S S1 aG0 S►�y�N� -7 <br /> �. <br /> K� �. CF-r/ CIA 23x39 -�-�6�j�j z <br /> Yactkty a YtYX12: _ <br /> gy, 9b.U.S DCT Descdpthxt irndudtng Proper Shipping Name,Haazrd Class,ID N mhos to Conta ners t t.Total 12.Unit 1 s.Waste Codes- <br /> HM and Packing Group(d any), No. Type Quantity VA rVol. <br /> I <br /> ) <br /> t <br /> 14.Speda,Handling Instnscu and Addir.Ara untia- <br /> rfomr <br /> alk) <br /> CA 016 <br /> 6 <br /> i 9 <br /> FkG t7 <br /> 16. GENERATOR'SIOFFEROR'S CERTIFICATION: thereby oeuarethal y e contents o£Nus consignment we£11lly and accurately described above by the proper shipping name,and are classified,packaged, <br /> rnari;ed and and are;-r all respects in Pr et condto for bransport according:o applicable kiternationai and na"II governmental regulations.if export shipment and I am the Primary <br /> Exponer.I certfy that the c ntenn h <br /> ts of this ronsiQent co lm ioate:erns d Me aractted EPAA,xow edgment of Consent <br /> certity that the n5le m r m ai 7n statement ident*e,'In d(1 CFR 26227(a);if I am a large quantity Wiemtorj or(b;(iI I am a SNA guanbty galeratur)is tnie. <br /> Generat a rotsPrintedrTyped.Nante Signature Monro Day <br /> / Y ear <br /> cf 4 :._ a <br /> 16:lydema!oral Shp !s �' I J - <br /> - - U import to U.S. L�1 Export rR m U.S on of enirylexA: - <br /> Transporter signatlue(£or exports only): Date leaving U.S.: <br /> W 17.TiansmortP AcY.nowledgment of Recapt of Materials <br /> I Tran er I PnntedTyped Name S gnatu a Month: Day Year <br /> ti ,.� .� 1 <br /> Z <br /> TranspUirio 2 Pr nted!"yped Name Signature <br /> Month may Year <br /> t- <br /> 18.OisaepancY <br /> -,aa.Dis:repan,.y Irdicaton Space ❑ cuanuty ❑Type r 1 <br /> �t Residue Partial Rejection r"r� <br /> u Full Rejection <br /> Manifest Reterertce Numbar. <br /> 18b.A.tic-ma;e Far�trty(w xnerator} - <br /> U.S.EPA to Number _. <br /> -J <br /> V - - <br /> Faality'sPnone� <br /> W 18c.Signature of Mlem~te Facility(or reaeratu? <br /> CD <br /> 19.Nazardousftste Report Managen)W Method Cordes(Le.,oodet for Hazardous waste Ireaknent,disposal,and re[yc6;g systems) <br /> O 2. 7T4 <br /> 20,Designated Fatality Owner orOperam CeA:ficafnn of recm of mazaraous matariafs covered b;rthe manifest except as nmed in Item,1ga <br /> Pr,,(iiN1T9���2'tir: Sigrtattirs � '- <br /> Month Day > <br /> -cPA Form 8700-22(Rev:3-05) Prf?vbus t3dltions ere flbsotet . <br /> n1; lExfr4AT1_} ACiLITY TQ 0EST'NAT10N STATE(IF REt�tJ1RED <br />