Laserfiche WebLink
i • <br /> Please print or type.(Form designed for use on elite.12.pllch)tyot wdlor. FannApproved,OMB Na,2050.0039 <br /> UNIFORM HAZARDOUS 1.Go,enlcrlD Number 2.Page 1 of /3.Em6rgenq Response Pdone 4.MenRest7mck gNumWr <br /> WASTE MANIFEST 1 Y..S� C-:P9 x'14—.SOZ 015384428 JJK <br /> ' Gonerala's Nano and hullagWdroas GepaparssbadeAddresstilai nl Oren madlrgaddmsa) <br /> /2e <br /> doe-5,-1:5 Glass proce55iflje s <br /> Z9�I N• 1V&-v vke \r\d, sfc�ch{{c tort, (01, 5 <br /> sf <br /> Generotofs Plana; Z•6.) ^r � — J <br /> 6.Transporter i Company Name EPAIO Number <br /> ,yJ-,, t !8 a-zz. <br /> 7.Transponder2 Company Name <br /> 9,,35+ N'Ll D U.�AlPA ID Nrmlberr �' <br /> 8.pa'sgnaled FacRly Name and$s{oAddmsa U.S.EPA ID Number <br /> �(S Ce 01vej`-(. k� eve dc. 89oc�3 <br /> flwy 95i f1'M11 IeS <br /> FacililaPhone: ©O1 vT 3-30010006 <br /> ga. 9D.U,S.DOT Desaipibn including Proper 6hlpping Name,H.rdClass,ID Number, 10.Como <br /> a r 11.T0481 12.Unit 13.Waste Codas <br /> HM and Paddrg Group(if any)) No. Type Ouanllry WWoI, <br /> Nfi 3o��i pza� ovs was t �r 1� 3q,795 P 'i81 <br /> PG <br /> 2 E ED <br /> 3 - <br /> 01 <br /> 4. N AL TH <br /> icar—OPAITIS Mq S <br /> 1•f Spetiat FnMPrg lgs0uu0nsand Addidomr In gun I O{A ! <br /> C�wy J <br /> 6-462 q3 - 1 51 c ,. <br /> 16. GEN BATOR'SIOFFERDR'SCERTIFICATION:Iharehy declare that the contents of Ods emdgnment era Ntly and eccuatety tlesnxlbad above by the prepersh¢png name,and aze dasafptl,packaged, <br /> marked and lebeledfplamrded,and are in all respects in proper condition for transpM.accmdng to applkaWo in:anadmraleiW nodanal gwommennl regua0ons.If oxpen sNpmml and lam do Primary <br /> Expoder.l cvgkthat the mntenks of Nls mmignmeni mnform iothe terms of the,Berhad EPAAcknwdedgment of Consent. <br /> I car ly lhallhewaste minimlzatlon alalementldenlified In40 CFR 26227(a)(III am a large qusm,ty9enMala)or(b)oil am a small quen18y generaWr)Is lme. <br /> GarwrotMU011omrc Pdnexurrypod Name Sipnar Month Day Year <br /> �YUW6R-"(0 (�)W qizbL V(7 <br /> J I6.IrtamrmN SNprnenia <br /> p_ ❑Importb US, ❑Expert bore U.S. Pon of entry/exit: <br /> Transposer all yorrepods only): DaleleavYrg U,S.;_ <br /> K 17.Tramponar Acknmeledgmenl of Receipt of Mannar <br /> W <br /> Transpoper,PnnleNf�Is. VC-5T �'cJN Iv y N son ;, 6 /G <br /> 0 <br /> Qmaeporles 2 r9inbv yped rine Signa - _ Mpnlh oar Yc# <br /> d <br /> 1- <br /> I <br /> 18.Ml apqanleaDiscreparwylndkellan SpamQuantity ❑Type ❑Residue ❑PenialRe)ealion <br /> ❑Fdlfte)ectlon <br /> 'Mon11ml Reformee Num c, <br /> 16b..Aa.:.. ;Facility(or Ganera:m) U,S,EPA ID Ndmbm <br /> J <br /> U <br /> rot+• FaaHys Phone: Manih Day Year <br /> ILA 18c.S7pnaLrce olNNmak PoGlay(a Gemrala) <br /> Q <br /> Z <br /> W19.Hazardous Waste Report Management Method Codes(la.,codes lar hazardous waste resonant,disposal,and recycling sydmre) <br /> 04. <br /> 1. ^ 2. <br /> 20,(kshnnted Facility dOwner or Operator:Cenl6celion of receipt of hxzamous maWals covered by 0e mM'IW except as noted in tied,10a <br /> illi PsnmdRYp try" 8: I Mmdr Ory Yoar <br /> LQJ <br /> FPA Form 1700.22(Rev.3-05) Previous editions are obsolele. DESIGNATE 0 FACILITY TO DESTI N ATION STATE(IF REQUIRED) <br />