Laserfiche WebLink
M -0 — cn <br /> v � 2ND <br /> O N� <br /> m OD <br /> 0 No <br /> O 3 (n 00 <br /> Form Apprpv®d OMS No 2050-0434 O Cn <br /> O Base print or We lFa m designed far use,on elite{12-pitch}lypewdtec} c <br /> UNIFORM HAZARDOUS I,Gerl ID u.,mtrr Page 1 of J Emergenry Responso Fhonr. 4.Mandast TrxYinQ Number O -6 <br /> JJK <br /> M WASTE MANIFEST � <br /> 5.Generalor's Name and Mailmg Addl GenemtNa Sre Address(if dr}rerent Man maHrng addn'ss7 p <br /> ! O <br /> If fs v <br /> c— <br /> CO <br /> I Generarofs Phone c- <br /> 6 Transporter 1 Companv Name U S EPA ID Number <br /> 7 Transporter 2 Company Name U S.EPA ID N—h- N W <br /> � (n <br /> 6.Des,gnated FaGlily Name and Sne Address U.S.EPA ID NI <br /> QJ <br /> Faalays PhMe'. <br /> ga. 9b.U.S.OOT Desatptirn Iinciul Proper Shipping Name,Hazard Class,Ip Number, 5g,Containers 11 Total 72 Unn <br /> HM find Paoklnp C—o pf ami' +3 W.*Codes <br /> No. Type Quantity W1 Vol <br /> f <br /> 7 <br /> M cD <br /> c <br /> C/) <br /> n <br /> � � v <br /> w <br /> 2 C n <br /> Lu <br /> 0 Q D <br /> 0 <br /> c <br /> v <br /> m <br /> CD <br /> n <br /> _,, ;I Hardnng Inst2ch-•s a^6.0.ddiiior:al Intomtalion O <br /> C) <br /> O <br /> GENERATOR'S'OFFEROR'S CERTIFICATION:I hereby declare that the contents of Ihis consignment are fully and accurately described above by the proper shipping name.and arp gesg5ad - <br /> marked and labeted+plararded.and are in elf O <br /> bDrr1Pr I respells m proper[ondipon For transport amording to appliraQle intemaliona and national governmental reguiafians,If export shipment and em the Prrryry <br /> mtity Mat the cordents or this mrefgnment oonfonn to the terms of the avaehed EPAAcknowled meet cf Consent_ <br /> Y aY IW waste msem®boyl staEmrent AernMed in 40 CFR 262.27(a f an:a large uan g <br /> li rg q lity generalorl or{b}(dl am a small quantity generator)is true (D <br /> Generala'&VeVs Pnreed:Typed Name Signatum <br /> MwMl Day rear Q <br /> t6 inl (D <br /> � ematipn�Shrprnents .N-. <br /> ~ ❑Import to U.S. <br /> TrarrspogeT Weaae ow axpods aHyl. ❑Export from U.9 pad of entry+'exit: 7 <br /> 1-TDate leaving V.S.: --__-- <br /> W tem al R""of Mall <br /> j. <br /> ; "e" dTyoed NAtriE <br /> K <br /> Signature alwtd+ 1'et' <br /> n <br /> Q 7ra.:sprte:�❑.-,,tc+`.Tr2+a-]Ydme _ <br /> Signature Month Do Mbar <br /> 18,0®vepancy <br /> 1 7 <br /> '�r` 'sPancY irgrcayan Space Q <br /> Ll TS cI ❑Residue ❑Partial Ref m. ❑FJ Rstacam fA <br /> 7 <br /> It= <br /> t8t.Aserryte FaoRy{a Gerreratpn Mandril Reference Number O <br /> JV.S.EPA Ip Number O <br /> Li D <br /> { <br /> LL Faolit±+s Pttpna- =:t <br /> O •&Sgrature v[,trirrrraa!F (D <br /> �r fa Gertererorl <br /> z •ami <br /> S <br /> m Ig Hdiirdots Wa�rftepon MlraRen,errl McNBd Codes(i e,.codes for hazardous waste 11"tmenl,tl <br /> t 2 Isposal,and reryding systema) <br /> 7. 4 U <br /> F�71t7Qater to C4ardlar:CerdaWaon of receipt of hazardous matenais cpvered try the manifagtn <br /> except as riled In Item Ian 0 <br /> Sgnetu e Q <br /> . t <br /> Prevtrnts a rll are obsolete p <br /> cc GENERATOR'S INITIAL COPY <br /> CD <br /> cn — O <br /> cSl <br /> 0 O <br /> I ) (> <br /> v <br />