Laserfiche WebLink
Please prim or lyes _ n deslgned for use on elite(12. 1ch - Farm ved.OMB No.2050.0039 <br /> 1.Genemla ID Number. 2 Page 1 a 3.EmageMy Reapome Phar t �jnp+�Num{hxp� ' A 1�[ <br /> UNIFORM MAZAROOUS r' i; ;1 a fj q n r ) 1 I;;UCd fie! �J K <br /> WASTE MANIFEST <br /> 5.GeneralofaName and MariNAMOSS <br /> I11ANIP1hL AliKr I l".t M1f3(tt r s �rt�Lhl�y-ltLC <br /> YXrCjI'��{r:tUt `�' <br /> T PKTOM M qs5 <br /> Genemlofa 11101-Irf / U <br /> B.TrenspodMi f?pnp"Name <br /> AuV EfiF7jROfvrFXeiJTA1_ <br /> 7.Transpoder2Com�panYName <br /> 8.Deslg,ated FFday Name and SNaAddrm : U.S EpAPFBaUUN <br /> [4CpGCUN <br /> 13f lF1Al(11 b'A4 A <br /> 110 +; 1) 0 x269 '2 <br /> Facill o8pl,6rWjlf+r,fYtf a;CA,C3 <br /> ger_ 9b,V.8160T oesaUUpn ikidudug Proper SNppirg Name,Hamel deal.ID Number, 10.Containers 11.Total 12.UNI 13.Wasle Cedaa. <br /> HM andpackmdaro(dany)) No.. TY" Quantity: VAAtN. . <br /> a <br /> (4'tl '( ttAI0- At OOI F~;1}A ti1`_,1_I£JI IL.! ):'r}ifl.l 10 -I_'r'!llil <br /> ( ll D t .j„), <br /> 2. <br /> 3 <br /> 14.SpedY and ..> 1 p ;.;•.1 1 T ., <br /> �IAER(3)t 98j 171'F�AfJFIlE pt 991` `AttlA 1NAL i;PA COD!8 �t31 ,fJdN�*APFROPgIATE p(R ONAI PNOTEC'pVE <br /> I'MUIRA NT <br /> 15, GENEMTOR'SIOFFEROR'S CERTIFICATION:I hereby declare thaNM content,oI"camigrment meafyam accaateydasmbed above by the po;;SNppirg name,abale Uassiaed,packaged. <br /> marked and labeledlplaoaided,and aro N all respeds N proper wort oa W uanspon aaadig to a OC”kltsmaUalaland national govemmwW regula5m.If export sNp M and I am the Primary <br /> Exporter,I tardy mal the eomants of me condgnmerd conlorm to the tames or Ute atadW EPAA&ooedgmenl of Consent. <br /> I carkth t Um waste minnnbacon sraNmenlWm*bd In 40 CFR 28127(a)(41 am A large qu8mtY generalaja(rj('itlam a'smeYWan4ry generator)Is rue• y Day <br /> � <br /> Oenere Sawoes Pdnted(fyped Name oylt ©/ �� <br /> Y C <br /> F .r <br /> S, I pme U ��ealmD�. ❑Espod lmm US. DateMnb U.& <br /> _ 7ransp 4M s'gaalum(for!sWf!Faah'1 ' Dela l6aWg U.S: <br /> IT.TrenspaNrAcknaMaepmantolRlwMpldMaMleh - Monm Day Year <br /> Transpaw I prindemyPod NemoSignaler, x. <br /> .."".. <br /> 1071 '1 IC <br /> J. <br /> Oey <br /> Tansporta 2 PridwietillYPOGNNaMaSgnaMre Manm Yem <br /> * 18.Disaepancy ;L1Full Ra <br /> 18a.�saepelwy.Indnarm Spee, ���, �Ty� ❑ftesldue El Partial Re)eUion MaUan <br /> i <br /> 1, ll 1 ' Merdlesl Relaerra Number, <br /> U.S.EPA ID Number <br /> 18b.AllamaleF Uly(orGenerata) <br /> U <br /> I< FaalihJs Phone: Monro Day Year <br /> i&.AmIurea lemate FaCilay(or Genemta <br /> 1g.Hazardous Wasle Report Mmegemenl McIW Codes 0.e,codes for hazardous waslo bealment,disposal,and recycling systems) <br /> D I, 11// <br /> 20.Designated FecMy Oenero opoM r.Carrsnuee ofwAptof hazardous materiels covered by themanAmiexcept asndedln Item 18a �r <br /> 1 S naWre <br /> EPA Form 870D-22(Rev..30) Prevlou,edi0ons are obsolete. TRANSPORTER'S COPY <br />