Laserfiche WebLink
0 0 <br /> Please print or type..(Form desi0nad for use on elNe(12•pitrh).lypewr)lor,) Form Approved..OMB Na,2050-0039 <br /> UNIFORM HAZARDOUS 1-Ganaela lD Number 2.P.agc poi ayRmporse Phomd 4.ManlfosiTraowng Number <br /> WASTE MANIFEST -©Dox�16 fs� �o� ALS 0.15384203 JJK <br /> 6.Gomm at atl Ma,ang Addlesa nosals'SlaA rocs in dulaenl than mating address) <br /> 2zvz slv�� c�rrL r�v� stogy <o� � v spa <br /> Gerara ce's Phone: <br /> a.Tmnsponnr 1 Company Napa U.S.EPAID Nanber <br /> T 5 N. )2 d�00 <br /> T.Tm el..1"7 Company Noma, U.SEPAa NumG.rr <br /> E.Mslgnolad Ferwb t4ima a++d SllaAddrss U.S,EPA ID Number <br /> a5 �CO(AC•tf AJEVA�� <br /> Nil 615-. 1i ,vb, LES s Is- 136 r36 wTfY � r✓EvwoA $4003 <br /> Fecgil aPhone: Ow <br /> gat, <br /> 9b,U.S.OOT Descdpmil111ch�ng PIOPar Shipping Name,Hazard Class,ID Numbar, 16.Containers 11.Total ff 13.Waste Codes <br /> HM end Packing Grcup(it any)) No. Type QuanliTy <br /> o 'N0 3077, t-K}zp 2JO�S wV}�CEe h <br /> K Lco PG 1 (fit <br /> 17 <br /> too <br /> 3. <br /> I <br /> l Handling Speciarisimilons amffiuldonol t tion <br /> M� 9 c, <br /> t n G+4 yt�a gas <br /> 15. GENERAT00.'SIOFFEROR'S CERTIFICATION:Thereby dedare mat lha conlenls of[his consignment are fully and accurately described above by the proper shipping name,and are classifxd,packaged, <br /> marked and Iobeled)placarded,and amin all respects In proper condition for transport according to applicable inlernationaiand national governmental mgulalions.if expod shipment and I am the Primary <br /> Expontar,I codify,that the conlonte of[his consignment confmm to The terms of the attached EPAAckiawledgment of Consanl, onarelm is hue. <br /> I partly that The wade mlNnlregon statement Identified In 40 CFR 262.27(a)till am a lege quantity geoemla)Or(b 'earn queen g ) <br /> G!noralau'dogamis PNilc-0Ry(,od Name Signa MOM Dap Year <br /> 16-0 502Tb iT�� o _ l C <br /> .� 16.Inlomallonal Shipments ❑import 10 U.S. ❑Export from U.S. Padufomry/edt <br /> F' Date leaving U.S.! <br /> Teetota a elgeetum(Iw oximbe Only): <br /> 11.TmtrapaterAcknmdedgment of RecalPl of Materials <br /> $004" <br /> Tmnspndal Pm MiTj*Name Month Day yen <br /> <1 ESf 'CJO V lid A) 6 a 6 <br /> Z¢ caTraposer 2 Prime Tyle di Namn Signabae Manm Dey Yob <br /> n <br /> I <br /> 18.Discrepancy ;P� (�� nnn18a.0isaepancy Indication Space ElQuanlity _lgyp� C'E Io ❑PordeRolnnlon ❑Full Rai llon <br /> Marpool Rnkreaca Number, <br /> r 1So.Alternate Fit 91T for Gwamta) ,y U.S.EPA ID Number <br /> MAY 0 2 eO�7 <br /> LL Fealty's Phone: <br /> w So,Slgmmare of Asema[a Facility(or.Gararotor) , r +'1 :.i Mourn Day Year <br /> 19.Hazardous Waste Report PAanagemant Method Codes IT,%,codas for hazardous waste tree[men[,disposal,and recycl'xg systems) 4 <br /> C <br /> 20.Designated FemNly Owner a0perala:Certification of receipt of hazardous materials covered by the manifest pi as noted in Item IUs <br /> Pi kaledTTlPcdSigrlaaxa . bagr Year <br /> '%91/MA dv- <br /> EPA Form 8700-22( uv.3.05) Previous odled Bare obsolete, DESI(iN)ATE D FACILITY TO DESTINATION STATE(IF REQUIRED) <br />