Laserfiche WebLink
m <br /> Lf <br /> r r <br /> o � <br /> rnoo �'o � � o <br /> v <br /> (.711 111) W(Q v0 CD 0 CD <br /> � NCn <br /> -n <br /> O 4, o C' Q O � <br /> Ln V � a <br /> TI TI TI Ell O 3 <br /> rrro 0 m <br /> i I I II mmm � Cn <br /> M IIIIIIIIIIII IIIIIIIIII �III N 1 � � � D' <br /> Please print or type. Form APProved'OMa No.2050-0039 M � N (D (0 <br /> UNIFORM HAZARDOUS�I.Qcpl Io Number 4.Mamfesl7raekingNumber N N O (D <br /> WASTE MANIFEST2.IPage 1 of 1Emergency Response Phone 014O3 0 5 FL E O O NO Q- <br /> 5.Ganerelads NameandMailidressco 0 <br /> Generators Site Address fifdifferent Nan ma�hng adtlressl � W <br /> 0- <br /> CD <br /> CD O <br /> 6.Transporter 1 Company Name U-5 EPA ID Namber <br /> Q m <br /> o = <br /> 7.Transporter 2 Company Nanre U.5.EPA ID Numhar � � <br /> CD <br /> 8.➢esignated Facility Name and Sile Atldress- U.S.EPA IC Numhar O � <br /> r <br /> Fauldy'S Phone: I I -i- Q- r <br /> So 9b.U.S.DOT Disim n inclul Proper Shipping Name,Hazard Gass,Ip Number, 10.CoMaina i 11.Total 12.Unit 13.Waste Codes (D 0� <br /> HM and Paclong Group trialNo. Type Quantity —' <br /> 1 y WI NMI. )( <br /> � r. , r r r 0 n <br /> (D <br /> 000 -a D <br /> rr N W W CO <br /> w 2 (0 CF) O 0 Cn <br /> C' t' i s I CrC`IF1 N 0') 0') <br /> O O CDO O <br /> 1 00 Q0 CO -0 <br /> 1j CF) LTI O <br /> s} D01.1 I 71 7l TI <br /> rrr (n <br /> mmm o <br /> 4:i,coco <br /> 0 <br /> C <br /> a. <br /> 14 Special Handfno Instructions and Additional Won—lion N N N O <br /> 000 "I <br /> 3 <br /> Cfl Cfl Cfl _ <br /> 15 marked and abeled paraMed and areCERTIFICATION:arehy declare that the corrode of this consignmea are fully and accuratey described above by the propershipping name.ani are dasslfied,packaged, v <br /> p proper eondilion for kansport according bappllrahleinlemationaland nadonalgavemmenfal <br /> Exporter.I muly lhalthe contents of this xlrslpnmenl conform to theterms orlheatoohed EPAAckrwwledgmentof Consent regulations.If export shipment and t am are Prime 0- <br /> I <br /> I certify that the waste minimizabon sialement identified in 40 CFR 2a2.27ta)(i£I am a large quantity generator)or(h)till am asmall quarblygeneralor)is quit. 00 <br /> renerelgrSiOaamrs P Inred,7yped Name $11 luirscn <br /> r Month Day Year <br /> � tu,..lniernational Shipments ❑Import fo u.5 ❑Export hon U.S. Pon of entrylexic � <br /> ? Transporter signature(for exports only): Dale leafing U.S <br /> K 17.TransporlwArk—Medgmerl Receiptat Malenals <br /> iTransporter I PirmedRyped Name Signal 1 <br /> O I Month Day Year <br /> Z 7r8naponer2 PnrnemTyped Name Signalure <br /> Month Day Year N <br /> 1a_Drscrspancy CD N <br /> 1 iaa Discrepancy Indication Space ❑Ooantity ❑Type ❑Residue <br /> ❑Partial Rejection ❑l Rejection C_C <br /> Mamlesl Reference NumhecC <br /> Tab Allemato Fan§ly for Generarorl 00 <br /> US EPA ID Number � <br /> J <br /> U � C <br /> r4i Fanlrty's Phone < <br /> 18c Signalure of Nlemate Facility(or Getwrmor) <br /> 4 Month Oay Year m CD (_ <br /> Y -0 0 <br /> LD 7 y Hazardous Wale Report Managementelnod MCodes U e.codes for it�rdous waste Irsonenl,dispoon� sal,antl recycling systems) <br /> O D � <br /> 0 1 g. 4 I <br /> C 2 <br /> 20 Oosgnated Fall Owner or Operator:Certification otrecejpt of hazardous materials covered by the manilasiexcaptas nded in Item 19a N N <br /> 1 PnnredAyped Name Sgnalure Q N <br /> Month Day O N O <br /> T EPA Form 8700.22(Rev 12-17)Provious fidirfone are obsolete 0 <br /> NFYRiI INN!-A1 T o <br /> M 1,VF} .e (n W <br /> (D Cn <br /> O <br /> O CD - <br /> (D <br /> O <br />