COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

Please forintor 4foo,(Formdesi fled for use on allies 12-pltc$ t pewrNor.) Form Approvod,OMB No.20540039 UNIFORM HAZARDOUS 1.Gress"WIDhaanbar 2.Page l of J.Finer rg Response Phase 4.Maniost Tmddng Member WASTE MANIFEST , �.,� fp 55� . �7 -sv: 015 3 8 419 6 JJ K S.G rremtofs Name and getting Address ¢Hondas Sia address(II different thari Null np addracs) WS aC- F1N1l/) e-5' '�Z�'2- '5. '5w4- Commons Phone: 6.Tmspoller 1 Cmrpany Nana U.S,EPA IO Number 10,4!z > > 1 "7`I 2- 7.Transpdkr2 Company Nim US.EPA ID Number 8.DedgnatedFvoij Name and SheAAdmss U.S,EPA ID Number �S 1Gc o(�t A✓c, IfgO A 13 z`ty Fsdnly's Phone: 2010 " C.t — .19 'v VT .S 0000 go. go.U.S.DOT Description(including Proper Shipping Name,Hazard Class,IO Number, 10.Comalners 11.Totat V.Unit HM and Packing Group III any)) No. Type Quandity, WI.Nok 13.Waste Codes o IIJ 30-7- 1 !>lYanP-,?0L4,5 w057E, 5eAV) .7 �G 7 C 0 0 3. I ' I 4. 14,$pati Iianding InaIN<dgns and A&BUonal IMormoUN �12�71XG� Gt�(.�ET /�✓> Po—� f 07 0 3Y5�3 -1 .SH -4�3 6 7-7.;?- 15. GFNERATOR'S(OFFEROR'9 CERTIFICATION:I hereby dedam that the contents of this consignment am fully and accurately desalbud¢bore by the proper shipping name,and are dassMand,packaged, marked and labeledlplacarded,and am In all respects In proper condition for bansporl according to applleable inlenra8anal and national governmental regulators,It export shipment and I am IM Primary Expodar,I codify[hat the contents of this consignment cordumi to the[arms of the a[ached EPAAcknoelodgmenl of Current. Icadify that lhp waste minonhagon statement Idenlilled N 40 CFR 262.270)11I am a large quantity generator)or(b)(id I am a small quantity generator)Is true. Genamloi sl09era'e PrInddMpod Name Sigwtme Month Day Year f�7462�9,0 602 76) e3EN S E 16,toonnallonel Sofpmeok f— ❑ rienta U.S. ❑Expodrrem U.S. Port of entry/exit: Transporter slgnetum(forexpore,onlyp Dale leavkg U.S.: of 17.Transporter Acknowledgment of Recoip[of Maurine tramp tort PsmteoffyinsOName &gnalt r Month O C6 ey Vear Tr nspnfdr 2 Pent ypoO .OR sirsholl Month Day Year 18,Discrepancy 18a,Discrepancy Indication Space ❑Quarto ❑Type si ,b v� RejoGion FJ I ,L,,U' ❑Full Rejection Rlkfor or. 18b.Alemete Facmly(or Generator) U.S.EPA IO Number 2Uil LL FacRtyrs Phone: w 16[Slgnaee a1APemala Facility for Goner; i11l 3Nlu V ikL i iC TN Month Day Year zPF IMM I Tf.=Z! m19,Hazardous Waste Repel Management Method Codes Ii.a..codas for hazardous waste treatment,disposal,and recycling systems) I. a 2 3 4, 20,Designated Family Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except es hoed in Ilem Ise Fenbd7fYllodi j- 61ynaWR et Day Yen EPA Form 570422(Rory.3-05) PD7vlops editions are obsolete, DES IGN AI D t-,o.CILITY-1 0 DES?-tNATION SLATE (IF REQUIRED)