Laserfiche WebLink
CCP* �fo(OG 857381 41380 <br /> Please piN or t 14 <br /> ylpe.t1 (Poon designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator lD Number 2.Page 1 of 1 Emergency Response Phone 1,Manifest Tracking Number g� <br /> WASTE MANIFEST :003895027 JJ K <br /> 5.Generators Name was Mailing Address Gonera m's Site Address(ff different than mailing address) <br /> BOBS DUO? C/O 3E COIFAIY 908E DUOT IHO5575 <br /> ISIS ASTON AB610E fill 781 O'AICY PAIIIAY <br /> General533@ <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 1st <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> V lJll�d1J 7 70 if <br /> 8.Designated Facility We"and Site Address LLS,E AID Number <br /> BOBLIBOYOB ENF1101MIAL, INC. IEWT FACILITY <br /> 21245 77TH A9E806 SOUTH <br /> Fadktya Phone; 110117, EA 98632 (253) 872-8136 WAD991281767 <br /> ga 91h.U.S.001 Description 5rlduding Proper Shipping Name,Hazard Class,ID Number, to.Centuries11.Tocol 12.Unit <br /> HM <br /> and Packing Group(if any)) No. Type Quantity WWoI. 1J,Waste Codes <br /> 1 01951 WE AHOSOLS' PLAMER, 1.0.5, (BEYBYL ETHYL SEiOBE) Dell 0835 331 <br /> 0RG 2.1 MT-SF12812 19(9191=111) <br /> w 2. M1263 NAM PAIR? 1ELA?EO BATEIIAL 3 FGII 19(01/1=111) 0661 0035 331 <br /> k " OO LI4DU v6ao P <br /> 3. <br /> d. I, <br /> 110 <br /> BOIILIE pD¢®AgTr1a pmpnYTRRI 8 aPTT ®y1fn1 <br /> 14.Special Handling astrodome and Adeidonal Informatlon <br /> 7 X �A1( <br /> (1) 90882.1-13 - WPM AEROSOLS (2) 9010l - MUD) 1LAIRABLE LOOSIFACI ( "P <br /> ( IOFOSAL4:24 DOOR EY81= CONTACT: (811) 451-8346 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I harsbydetlam lhalOre contents of Ws consignment are fully and accurately described above by the pmper"ang name.and are classified.packaged,' <br /> marked and laheledlplacarded,and are m all respells In proper condtbn forasnaµut according m appticeble lamination nd national govemmentat regulations.If expuO stA mwAand I am me Pdmary <br /> Exporter,I catty thatthe contents of this consignment conform to the tams of the attached EPAAcknoMadgnenl of <br /> Icertify that the waste minlmixa8an statement identified In 40 CFR 282.27(e)(11 em a lags Quanlilygimanda)or small genembr)is Wa. <br /> GaneralorsrOgemrs PrinleNTypad Name -Sgns Month Day Year <br /> _..Fn __. . loci w <br /> or <br /> J 78.Infemetional Shipments ❑Export eon U. POR of en <br /> F ❑Import to U.S. Iryfedt: <br /> Transporter signalure(for exports any): Dale leaving U.S.: <br /> Its 17.TranspoderAdmmdedgment of Receipt of Materials <br /> Traaparler 1 PdnlediTypco Name Signature Month Day Year <br /> zj <br /> Transport PriMedRyped aSignature Month Day Year <br /> TO.Discrepancy <br /> 18a.Dismapancy lndcation Space Quantity []Type ❑Residua ❑Pardal Rejection ❑Full Rejection <br /> Manifest Referenco Number: <br /> 18b.Xmmate Farality(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facilitys Phone: <br /> 18c.Signature ofAltemete Facility,lot Generator) Month Day Year <br /> a <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(ie.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> i, 2. 3. d. <br /> 20.Designated Facfiry,Owner or Operator:Certification of receipt of hazardous malarial;covered by Ne manifest simian noted N Ile <br /> CF <br /> 110 m Day0.22(Ree3 5) Fheviwe editionsareobwlete. DESIGNATED FACILITYTO DES ION STA E(IF REQUIRED) <br />