Laserfiche WebLink
Please print ortype, Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1 1,Generator][)Numbar 2.Page 1 of 3,EmResponse <br /> Emergency Phone 4.Man t Trac n� umbar <br /> WASTE MANIFEST amllkw 1001785768VES <br /> 5.Generators Name and Malting Address (�ALYAIK Gerherators Sda Address(IfdMarent than mallfng address) <br /> YULINIArMEXCROUND BAW <br /> sf><!s sin WAT <br /> �tO. A W> rn.7217 <br /> mum <br /> 8,Transporter 1 Company Name U.S.EPA ID Number <br /> VBWJA IN THOUNWAL @O=OM N f 13 0 1 0 6 3 1 3 6 9 <br /> 7,Transporter 2 Company Name U.S.EPA 10 Number <br /> 8.Designated Feetity Name and Site Address U.S.EPA ID Number <br /> VE0117A 1%THQVW1 L 8=MM% <br /> Liz <br /> Fade a Phone; a C A r 0 6 0 G 1 4 6 7 9 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contelnera <br /> 11.Total 12.Untt 13.Waste Codes <br /> HM and Packing 6-1)(Many)) No. Type Quantity W Wol. <br /> o X 1' UNIML WAFM 1 UrAN%3.1 <br /> 1 C r 3d F 331 <br /> CD 2, <br /> CD X DOM WAe'1>1 PXWANK 2,1 Upp2 <br /> 1 C Y 3 1 P 371 <br /> X 3, UNICIA CARKW M0]=12 <br /> 391 <br /> 1 4 C T lI P <br /> a. ' ,=A BAZAIWO WAM fIQh36 UAM PMT 331 <br /> 3 D M 337 P <br /> tor,special Handling Instnrctona endAddibonal Information <br /> ER 300"tJvetsWW + +�twvt oq•re�n <br /> �ory Iq as Ylld F 11M <br /> A3�E'M11141 �>�113 aaO1lm0 A�J1T4B �>� I= <br /> 79cRe1 1dmX +�i iv�msls #HM <br /> �rAt'f77l19 <br /> 15. OENERATOR'SIOFFEROR'S CERTIFICATION;I hereby doom that the contents of this oonslgnment are filly and accurately described above by the proper shipping name,and are dassMed,p"ed, <br /> marked and labeledlplacordW,and are in all respells In proper condition for transport according to applicable latematrorWand national governmental regulators.M export$NpmmM and I am the Primary <br /> Exporter,I cantly that the contents of this consignment conform to the terms of the attached EPAAdmohhtedgmenl of Consent. <br /> I caNfy that the waste minimlzatim statement identified in 40 CFR 282.27(a)(M I am a large quantity generator)or(b){dl am a small quantity generator)is bue. <br /> GeneratorslOffeWs PrintedlTyped Name Signature Month Day Year <br /> 6N &I&A. <br /> 18,Inlemalional Shkprnenta <br /> ❑Import to U.S, ❑Export from U.S. Purl of entrylexM: <br /> Transporter signature(for exports only): Date leaving U.S., <br /> 17.ThansporlerAcknowledgmentof Receipt 0 Materials <br /> Tmnsporbsr 1 PdntedfTyped Name Sigalf <br /> Month Day Year <br /> Ake,t>IQA>b 11T ,�' <br /> Transporter 2 PtinUryped Name Sig tum I Manch Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Paniial Re)ection ❑Full RepcWn <br /> Manifest Reference Number, <br /> 18b,Allemale Facility(or Generator) U.S.EPA ID Number <br /> ci <br /> w Facilivs Phone: <br /> 18c.Signature of Alternate Fadlily(or Generator) Month Day Year <br /> N19.Hazardous Waste Repot Management Method Codes(Ls.,codes for hazardous waste treatment,disposal,and recycling systems) / <br /> J G 1. � +.I 2. /q/3. //�/ 4 <br /> i !TL �/ <br /> 20,Designated Facility Owner or Operator.Certficatbn of recelptof hazardous materials covered by the manifest except as noted In[tam 18a <br /> nted/Typod Neme nature <br /> C���w� Month Day Year <br /> OYI/3 Z/ <br /> EPA Form 8700.22(Rev.12-17) Previous edit€ms are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />