Laserfiche WebLink
55L St S9TPol 211315.)3071_2 I III 1111II1I11 1111111111 <br /> Piea5e print or Type. <br /> UNIFORM HAZARDOUS t G <br /> 'e' I of 3 m�,Ras arse Pncoe Num�iu <br /> WASTE MANIFEST T P 0 00 GQ�1205 <br /> _77,76re—rabrs(Jame and Mailing Adaress 009320872 S K 3 <br /> Genc,ov c,a AkTo5n 1 0,w.3-1,1- <br /> Pa <br /> BLVI <br /> SALIDR CF! 9 5 F; <br /> Gerewor,-�,Phan <br /> Traisp;rlef 1 Gen pan}Name <br /> Y5 T r U 5 EPA ID Nwob­ <br /> T P <br /> U 3 EPA 10 NurnLer <br /> CLEPIN PAR.-.1-iRS EhV '3EVVTGES 114C, <br /> A DesSjratod Facfey Marne�andSde Addess j. IfED9,293222-Ij <br /> PVr'TY-KLE[N '7YSTEiT;: 1W us EPA ID Nj.mb,: <br /> —T <br /> oa ob U S DOT oj,crip!Jm(including P,cpe,Sr.pr rg name.1tazxfj Q155,10 Nurn4e, 10 Canlatrers It -oal Q L.I_&I and Pack$nu Gmup rd anyl) 14Q 7� �:.anl.tv Y�j 13 Vlaslec)dos <br /> 0 H-P <br /> w <br /> w <br /> IVA <br /> H K I t <br /> HAZtIRDOIJS W9 TE L <br /> (ACLIEO! 3 PARTS WnSKVS0EUT-uto <br /> 4 <br /> SpeclaiHantj!irg InSINCIfflPs and Mltlicnjl Inlormalan <br /> TSD:SCA <br /> 2W EFTEP.GEt �'ItBDO--5B-1'60-rl�q,,3r�/'TFI-Conti-;k;--t rQiaiA-­J bV e ri aj f 1 v on initial fr�%n!;po,--+Pr <br /> '0 ?dd or ir <br /> S 0:1 1,1- �,��� - <br /> j <br /> 75 GENEPATOR'SIOFFEROR'S CERTIFICATION:I rw-bv declare <br /> wvper ;F4.9d nalional C', 1,rnmanto:ot gjIntor-s YFxpol�-rrrerF a-L!a�1he F.nnar, <br /> Etporier I wnl�Thal the ccrw[5 011p15 con5ignmell flfum v)L"e le'Mtll'a A!:aC�E31E.PAAc��,,JWq.nj C� <br /> I Gerdy thRl jhe'&2S:t Mo,wizalon Sial,meni dg�lftd:r 40 CFR 262 27(,1)!df lama-af.e qr,ln;v <br /> klurO Day near <br /> lb Ina trIdI.Val Shp...... r <br /> Transporter qnsture Ocr riporls GrAy) Oafa Li <br /> Ix IT TraispivrerAckno"Iecy�,enl of Rerquplof Matenats <br /> LLI <br /> Traqmoir 1 Prin-M,Tyreo.Name <br /> b.—I_7B771 <br /> z P'"n-:961TYDed PI <br /> gK <br /> Mcr,-,l Day ew <br /> 2M <br /> 15 D�Svevancr t 1 M 1 <br /> I Ba[),:,7Lpar.cv Ind.rp,,n Space <br /> 18b AlRemate Faclity(or Gequioarj <br /> U S EPA 11)ekmhp- <br /> FaciliIy's Ptn"? <br /> nLu 18c Signature 4Ajjemjj17^_acI,[y for Generaicrl hinnih D3V YOX T7737 <br /> W 19 I`42ardGus Wavle P!P�O MX'agenlef I',ir-Ikd Cc des i.L wrts fu,haza[gous A"IL ITUVF.�n: .SDr;,If and fl.', <br /> LLJ <br /> 2 <br /> prfl:fdl­rfYped Name 5.r <br /> Lm 0 <br /> DESIGNATE-6 F4C1LI7Y,*EPA's a-MANIFEST SYSTEA1 <br />