Laserfiche WebLink
Sep 1.9 08 09: 05a STKN MRZDR LIN/MERC KIR 2094772084 p. 3 <br /> Please print or type.(Form desred for use an elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1. W ID Number 2.P age l of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> WASTE MANIFEST 173 z g�-Ifz q.3®0 0 0 0 8 9 9 210 JJ K <br /> 5.Generator's Name and MailangAddress Generator's Site Address(if dinment than mailing address) <br /> Generators PhO ��7Ti/�j Li y <br /> 6.Transpog7Company Name/ ' s'_ 7 U.S.EPA IO Number <br /> C1/ejt 2trl . (liV/¢ AMZr k eG n_ v/G c r Cfl.9��FYi�l3� � <br /> 7.Transporter 2/J:ompi m�/NaMW <br /> mklef-r �./�L 1�'i��//h C U.S.EPA ID AOO 77S.z7 <br /> 8.Designated Facility Name and Situ AAdddmos �jx��u�-T� U.S.EPA ID Number <br /> �11�(ye lo,45V 6�sT" "'Z�A-d ff zg s33 <br /> 77s_ (� icti/� �/6�• dPF o� <br /> Eatery's Phone: <br /> go 9b.U.S.DOT Desaipion Winning Proper Shipping Name,Hamrd Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM an Padong Grrxnp(C any)) No. Type Quantity WI.Nol. <br /> z- iU,r// 5`� / I /00 213 <br /> 4a �oJoGCiblzJ' �� <br /> z 2. <br /> w <br /> r, <br /> 3. <br /> 4. <br /> 14.Special Handlinglnsbucbo and Additionatlnason <br /> /LG 3 <br /> 15. GENERATORRSK)FFEROR'S CERTIFICATION:I hereby dollars that the contents of this consigrvnenl a2 Nlty and amaately described above by the proper shipping name,and are classified,packaged. <br /> marked and Iabeledoacamed,ark aro in all respect W proper condition for tansportacwrding to applicable imemationeland naturm19evemmentl regulations.It export stpmant and I am dm Primary <br /> Exporter,I certify that the contents of his consignment conform to tthelnms of the attached EPAAcknowledgm on L <br /> I costly that the waste ndmmizalion statement identified in 40 CFR 26227(a)(9I am a large quantby go )or(b)(il l am smae entity generator)is hue. <br /> fslOgemes PdntdR Name Wm Month Day Year <br /> TT Paul <br /> ( o /& 1667 <br /> 16.Intemadonsl Shipment <br /> p_ F-1 Import to U.S. ❑Export frau U.S. Pon of aniry/axiG <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> K 17.Transporbxpcknrnvkdgment of Receipt of Materials <br /> Transporter I Pri yped Name Signalure Month Day Year <br /> a <br /> QTranspo 2 PrmtaMyped Name Signator Month, Day Year <br /> z <br /> r <br /> 18.i Dtorapahhcy 18a.i icrrepancy Indication Space ❑ Quantity ❑Typa El Residue ❑Partial Rejection Ll Fug Rejection <br /> Manifest Reference Numher. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL <br /> Facility's Phore: <br /> w 18c.Signature ofPllemate Fadliry(or Genmaux) Month Day Yam <br /> a <br /> z <br /> � 19.Hazardous Waste Repoli Management Method Codes(Le.,codes for hazardous waste trealmenl,disposal,and recycling systems) <br /> W t 2. 3. 4. <br /> fO ' <br /> 20.Designated Fablity Owner or Operator.CertGration of reason of hazardous materials covered by the manifest except as noted in Item 18a <br /> 1 PdnleMyped Name Signature Mnnsh Day Irear <br /> PP4 <br /> 9-97w-" a-,7-M D.v..:,u,e <br />