Laserfiche WebLink
A <br /> „ ..ASN ' T.'. 0rm tleslgned foF;usa o Cde 9�-p wrfter.) Form Approved.OMB No.2050-003.4 <br /> OUS 1 Gefwtor Ip#fiDrrber 2 Pepe 1 of 3. penq ResPwue Phone 4 Manifest Trasltfrtg Humber <br /> lR :c AM �0�7s-ic�66 <br /> ooss JJK <br /> 5.Gineraborlaftmow Ma rg-M&ess GeneraWs Site Wass(d d f&wd orae madtrrg sd*ess) <br /> d it Simplot corfwny <br /> .16M'HoMand Road <br /> Lamp,t„A 9w USA <br /> Genenitofs Ptm e <br /> 6.Transporter 1 Company Maine U.S.EPA ID Number <br /> OJII.ARO ENMMNMENTAL SERMCES 4AMS25234M <br /> 7.Transpurter2 Company Name U.S.1�,4ID Number <br /> 8:Desrgnalad'Eadfip!t�ama aiid Sb Address U.S.EPA ID Number <br /> # Ei -Ad- <br /> an o A t 7-Q-USA <br /> go 96 <br /> esa <br /> ;1J,S OTT ftRquding Proper Sfdpphrg Nares,Hazard Class,ID Number, 10.Carrt&M 11.Total 12 MI 19.W45%Godes <br /> .and:Pscld�igLa+rP(Harry)) No. Type Quartoty WL". <br /> :a II[Mt ,V!i'okeCYattlGaS.hio'1jafl}C,SON.MOA.6.1JOP06 aim <br /> �t3Iv wi Waste OxldlzMg UgWd:mo.s.,S.1,POH P 1 <br /> a D� Jb <br /> 31it M.WaS1e.Mercuur Carl kmmd6,Uquld.n.0.6..6.1.PGp i <br /> 01 rp <br /> PO <br /> 14:�peciatlfandling tnstnictfons andAd6rtional Infornra&orr <br /> ' I33r$Jti8;F13d97-0Dt <br /> 15. GENERATORWFFEROR'S(3E MCATIONf;thereby declare doom=ft*of this oonsigrrmerit ate fully and and are dasslfiW,*raged, <br /> Cnftl arrdiabeleXplecarded,and are Ind In ptopar cot IMM for harapDrt modrtg tD ap ffi able hdema6o o and naficnal govemmsnlat reguk6orrs tf bn shipment and I am the Pdamry <br /> F I that ors r of orfs oort�rarrerd eorrtornt 1O$re terms of ora ettadred EPAAdmawledgmerd of CansanE <br /> I oertifli that ora waste mmfrnikagm statement MerrOW fn 40 CFR 262.27(a)(B i am a targe grrardrTy generator)of(b){di am a amen quantity generatA is true. <br /> �sPdrttedfiyped Signature Moo Day Year <br /> a L 3 <br /> 16.! 5firiprtrer>is ❑hW ID U.S. ❑F ort from U S. Poi of arAryfeA <br /> Transpertersignahrre(far axpDrfskrdY}: Date Waft U.S-, <br /> �, 17.T. alRsoe�rtoi <br /> Marth Day <br /> T. 5grrehrre 6/�J'► <br /> a <br /> fe 2 Pmttedlfyped NamMeath -Day MeDay Year <br /> if3.Discrepancy .. - <br /> 18&Discrapanc7t hrffca6Dn Space ❑ Qtr'* ❑Type ❑RssMue ❑PerGal fie}eaich ❑full lZa}ectDn <br /> Manifest Reference Number.- <br /> s8p.Abmatafmft ofC,eneraEor} Us:,ERAmNvmber <br /> pfAOemstef or3�err�talnr) Mordh Day Year <br /> ' t3 r14 , 5t .?arrdtecYdla9 } <br /> WO <br /> NO <br /> jO0 2�� E a I 1G 1 1 IE 17�f SES NATION ST)WE-OF-Riopi�i�p) <br /> i. - - - _ <br /> -k,�"n �a� : - <br />