Laserfiche WebLink
Please pdoFor type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.01,18 No.2050-0039 <br /> tINIFORMHAZAR000S 1.GaneraalrlDNumber 2.Pagelo( 3.Emergell Response Prone 4.Mannyest TrackingNumber�te "g <br /> WASTE MANIFEST ,-,; 3 1 r..7 - y �( t r�l FLE <br /> Generators Name and Mating louress Generators bile marses(it d erem than mailing address) <br /> W,'A SwurP:!$t CibiY;ainrr <br /> +i13 c, t-ralro ! Stmt <br /> -.. :;A 6-215 <br /> Generalors Phone: 1T. <br /> 6.Transporter i Company Name U.S.EPA ID Number <br /> z— CARIMM540 <br /> 7.Tmnsporler 2 Company Name U.S.EPA 10 Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> r,h;4 J GYavinicJ Trsatnent <br /> Eft BIW WE <br /> v , INw+87107 <br /> Facility's Phone: 505l <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers11.Total 12.Unit <br /> HM and Packing Group Of any)) 13.Waste Codes <br /> No. Type QuantityWWoI. <br /> UNW1 Walla Falyle nUl lia idc;,n.o.s.44Cebil Medd <br /> X Acetate),3.PGF ` 1 _Z P 214 ! 0001 <br /> ?QA1!�93_Wan;e %om?D3sleYgald uoy (Ndecanaf.n ---- <br /> c� koClaTarTl), �-omta-ar'!-?GV- CM- _ P <br /> J <br /> QUfg12fi:.-1Yaei ia-IvducYn �arnt 2ACgm.aaarnel. <br /> )t sial Amla,-sohimicaaw vartisti,poy,`-�`�. bq �y e � OF- <br /> ��yy� Q41�.+a4-1it1�uR^', A'4d l�pt� ./ F. <br /> 4. <br /> I <br /> { <br /> L Speuel Handling lnsWdipns and Atldabnal lnformaapn ftla Ji NLIn Ef 144=3 NCRnftlik Q/72923 <br /> I ER(3Ki713; ACT72817 PAA-il_ .�l l J.7 <br /> -,j_E63t3rt�rt E.CTtd1a.EPI.. :� `_, <br /> 13 GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the conlerre of this consignment are fully and accurately described above by the proper shipping name.and a2 classified packaged, <br /> marked and Iabeledlplacerded,and are in all respects in proper condition for transport according to applicable international and nit 0iml govemmental regulations.If export shipment and tam Its Primary, <br /> Exporter,I cer.dy that the contents of tnls consignment conform to the hail ltheatbdred EPAAcknowledgment of Consent." - <br /> I'cen"afthe waste mintm¢ation statement dentfied in 4D CFR2fi47(a)*lama large quantity generator)or(b)(if l am a small quantity generator)is tree. <br /> Genemtorsl sPrided/Typed Rama_ - �gna ureworth MF ear <br /> 1 16.Internalal.Shrpments: - <br /> p- ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Trans orterstature(for exports onl I Date Icavin U.S <br /> w 17.?ranspo Acknavledgmentof Remiptof Ma%en s <br /> Trarsporter l..Prima Name signature Month Day Ywr <br /> K Tansponer2 Pnm yped Name gnmure on ay ear <br /> 1-- <br /> _ ♦ 18.Discrepapcy.. .-., _ _.,._ _ __ _._. _._.- -_ -_,..- r, - ._ c. ..._ .._ _ ___._ � . - _ <br /> {IIII 18a.Discrepancy Indication Space '❑ Quantity ❑Type ❑Residue El Partial Rejection ❑Full Rejection <br /> Mantast Reference Number. <br /> 18b.Alternate Fadliry(a Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fach 's Phone: <br /> W 18c Signature of Alternate Facillry(a Generator) ^„ Month .Day Year <br /> 'g.Haiamous Waste Report Marnigement Method Codes(s..wdm for hazardous wasle treatment disposal,and recycling systems)' <br /> 7-7 r._., <br /> 20 Designated Facility Owner or Operator.Cenrtcxion of receipt of harardill materials covered by the man`est except as noted in Item 1 Be <br /> 1 Pdntedr1pped Name Signature <br /> Moral pay year - <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />