Laserfiche WebLink
Please "I or-Wi[Ferm dreUgiled for use on elite 12 heli1 ewrile[) Form ro'Jod.OM6 No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Oenmatw lD Number 2.Pege lel 3.Ennx maty Rosponso Phone 4'015384422 <br /> Maittow-tracking Number <br /> WASTE MANIFEST C _ , c�LI.-,L. -r - ,�� 015 3 8 4 4 2 2 J J K <br /> 6,13rimcalar$Name mrdmidngAddress - aws6UeAdUressH raffmAt Ulan mi StIdmss) <br /> ge&e 65Y.S C Glt- F'J� s l�CkTUiv �r3 as s <br /> StNU �+t� <br /> GOltumlors Phone: ."�� • ~ ' <br /> 6.Transporter 1 Cwnpnny Noma US.EPAIO N1Mntm <br /> 9 [ T. S J°� 7uA/ sEKv(��s raa 15EG� <br /> 7.Transpoder Y Company Nome U.G,EPAID IJumlier <br /> 6,0esignaled-myriamearid S6aAUdress d ( U.S.EPAIDNiffraer <br /> Gly !W/o y 1✓�v3��i4 2� <br /> fod�4yNvs Phone: <br /> 0 <br /> D, 9b.U.S.DOT Description(mcluding proper Shipping Name,Hazard Class,ID Number, 10.Conlaifle 11,Toml 12.Unit 13.WmIs Codes <br /> IfN4 and Px1lDVGmop(Uany)) No, Tyne O;mAlty W11Vol. <br /> C NA 3 17, t ea-�' i.,' l,.''v;s'l�, sour: yQltoo ($A -�ooB�_. _. . <br /> a <br /> w 2 <br /> R _ El _ <br /> 3. AY 32 �}� - <br /> 4. 4A <br /> i° RYI ESI 1 <br /> e.6podal Hondkig Imwcuais altlAddlUasal Infamalbn <br /> e 0,�2- Cfr'�? —( <br /> fru. GENERATDII'SIOFFEROR'SCERTIFICATION:Ihemby dedare that the Wpepfe of thiswro!ynlnam are lullyanoaa.Urately described above by the proper starting name.and are dwallied,par.4aged, <br /> markaf mad labeledltlacliolvi and are bs a4 mspeds In propel wndilian For transport according to applicable international wild national 9"mincolal regdelions.11 expod shipment and I am the Prknary <br /> Exposer,I mAvy that Ute Dentenls or this consignment conform to the terms of die attached EPAA.c'mmvledylrmnl of Conwell. <br /> I molly that the waste minlMisfpn sla!amanl identified M 40 CFR 2820(a)(if I am alarge maintily ytneralor)or Hill(if I am a small quantity m:naraln)Is Ime. <br /> GannleM's10Umms PrMlaVrypod Home Slgnilmo Month Day Yam <br /> �R Z oz 16 <br /> tO.InbmatlenN smpmonls LImport to U.S, ❑Expert from 11 S, Pal of entrylexilt <br /> z <br /> TroHoer k <br /> sl1paving U,6.: <br /> 17.lmr.Inner AdmaleclgnaenluFR 10 of Materials <br /> E Tran- furl PdNodflypedt. <br /> Signature Mdntn Day Yew <br /> O <br /> z line. .alar. dmodrt(yvj .Two <br /> J 519rmWro 41onUs Day Yew <br /> } 16.Oieuep rity <br /> 16a.Disrepuacy Indication Spay. El pari ❑Tip, :�Res'dun <br /> ❑Padiel RejeUlpn E Fill Rejedian <br /> klne6osl Awn— <br /> TOE <br /> eln—M1411ntaer: <br /> rY.. OEyeb.p F.irIMy(a G0ACmlar) U.S.EPA IO Nvmhm <br /> J <br /> U <br /> t4i I°nOl,I Phone: <br /> w 16c.5ignawro ofNfarmte Fachly(u GenEralm MonUr Doy Yom <br /> a <br /> z <br /> � 19,hlacvdws R9sle Report Management hlalhod Codes(i.e.,costa far hazardous waste Uealmenk disppssl.and regnliun syslenrs) <br /> 40.O:ai;pralM Family Oxnar or Operator:Cedilicafiah of receipt of Iwzardws materials cmnrrd by Ihn mani'flat emepl as 11011 m he'll Ina <br /> PraaedilY !9r are .0 dl pa% Yeaf <br /> L1�tAVht VY���c c� <br /> EPA Form 8700.22(RoV.3-051 lamn os edilems are obsolete. qei:;iR!e:!7FU Ff••,i:iLITY TU DESTINAI IUW STATti(IF` FIEC:UIFlEO) <br />