Laserfiche WebLink
ase Prot or. type. (Form designed for use on elite (12 -pitch) typewriter) <br />UNIFOWHAZARDOUS I GenereforlD Number Porn Approve.:.. <br />2. Page 1 of 3. Emergency Response Phone 4. �Maynglfos Tracking Number R No. 2050,00 <br />WASTE MANIFEST C% {, $ �k R a fi 1 Z 'k Ke",.t,. �' 64730 J� <br />Generalols Name and Malting Address"'" &6 ,ter t,{ 4"F3E'k,+'oen Generators Site Address fdigerent 0tan matlmgaddress! <br />a;*".i:t7pb 0 <br />1010 1464�;qffi! <br />13U)CW6011 CA 96M <br />Generators Phone: 2 f, 61 <br />6. Transporter 1 Company Name <br />iY6€9*nklrhf _ t skrr.a-dEMPe•§ONE„(`M#4`sZ BSB ,bN `�� 'Z `Z�desa� U.S. EPAID Number <br />7. Transpoder2 Company Name ' (} it 7 fit 7 eZ y <br />p� ��U�VbPdaB'i�8Y1fiz � �a��S U.S. EPA ID Number <br />d. Designated Faplity Name antl SREAddress <br />k^' `AFS - - U.S. EPA ID Number' — <br />34A4 <br />r.&7&DWf# TH U474 <br />Facility's Phone: 931 37Z1Z <br />gm, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, - 10, Containers HM and Pecking Group (R any)) 11. Total 12, Unit <br />1No, Type Quantity WWII13. Waste Cures <br />G c / <br />OF 0> lot <br />is Ile, <br />.w i�'A, 1.N7 <br />GENERATOR'slOFFEROR'S CERTIPICATION; Iherebydeclare chat the conlenis of this consigivir 1 Fare fully andaccurately described a,. <br />marked and Iabetedlpeounded, and are in all respects in proper condition for Transport according to applicable International and national govE <br />Exporter, I randy that the. contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />cediy that the waste minimization statement identified In 40 CFR 262.27(a) (If I am a large quantity generator) or (b) (if1 am a small quantity <br />r tdrs1OB or's Pnnted/Typed Name f Signal re <br />remuonat anipmenis G <br />❑Import to U.S. ❑Expertf U <br />Tmn poner2 Prinled/TyI dNama <br />r �ry'rt P, 3<'v'h _. <br />V8a. <br />ancypancy Indiragon Space <br />❑ Quantity <br />n <br />20. Designated <br />Pdnled/iypedP <br />EPA Form 8700.22 <br />'rey(ods editions ere <br />proper shipping name, art are classified, <br />�gulallono If export shipment and I em the <br />Is ime. ` <br />rom .S. Port ofenlry/exih <br />Date leaving U.an . <br />signaf� <br />Signature <br />Type ❑Residue ❑ Partial Rejection <br />Mandesf Reference Number. <br />U,S. EPA ID Number <br />us waste treatment, disposal, and recycling systems) <br />nenaIs covered uy the manifest except as hued In Item 16a <br />f /tic <br />Aonm Dey Year <br />Aonih Day Year <br />❑Full Ref eclion <br />7 <br />DESIGNATED FACILITY TO GENERgi®� <br />