Laserfiche WebLink
Please pont or type. Foml.desianedfor use On elile.(92•pilch)typewolen. Form A roved.OM6 No.2050 <br /> UNIFORM HAZAROOUS. 1.GenemrorlD Number 2.Pagdlof 3.Erlefganey Response Phone d.Manifest Trac king Number <br /> :WASTE MANIFEST p "1fs. .,dfiblj: 5 ZfiAi0.Oda0 6 JJK . <br /> G4nsrelaes Na...no WwrigAddrbas; .... ••:;rn; . <:sGaneralots SReAddtdss of different than mailing add=) <br /> c.,.on <br /> P0IJTEftWlPT IRRICs.AT1014 <br /> q on S•JAClerbot RP. <br /> General ors Phone ^'• •d1^DdECd•;i,a';;;:o.• . .; <br /> '6.Trans anerl.Com an Namei� , :.:r.:. .. ,; .;•,,:.: <br /> GeOPRH VAs.tfNltt�AT7Si:'' ::.;:.. ..,,:<::;.,,: ., - . ;... . '• <br /> i d1:S.EPAID <br /> Number':;.G':•r.::v,:t•.:6•, . <br /> 7.7rnnspodet2 Company Name . " ' ' U.S.fPAID Numbdr <br /> e.DeI�f�gf�Id �a�C:'. . ': .n': o:r.....:•. .,.. U.S.EPA ID Number <br /> .:.;:.. .. y...;.,. <br /> ' Oi9SHkSF.If:W,C,0 33:x07 : ... , . . <br /> FaelA ts Phone:."..IBFat ��. <br /> ga. 96.U.S.DOT Dasyi boil:aadin <br /> r ,. yi7ldeYR P WA(hAieEA}UPro9A'etrSiLaPn 9 NdmdI,.SHR?Y(a�ttsi.plDnNHu4mn�ber„);>.'.:. <br /> tg,,ContaNe?$tECIwre,;. . .. ..;.'It_T�olel: :;: .:1 nil .:.••:•”..,1•8Waste CodesHM endPac2'ngGoupNeny)f No.. OanlNNoI: . <br /> Yh� <br /> . ,• :, PAS A ask <br /> 3. <br /> _N <br /> A. <br /> Specie on inti nut rd ions dnd Additional Information <br /> � S*037' <br /> 15.'GENERAT0R'S70FFE9OR•S CERTIFI,CATION;.I hereby declare Nellha'oontenls of this carelgnmanl are Nllydnd acematelydakmbed above by the proper chipping name,aid ereolBselded„peekagea,�,', <br /> marked andlabeled7plaborded,andars lnallrespacls-In proper conditionforbrnspod armrd'ng to applicable inlema6onaland datenril gevammenlel raguleggns.If exportahipm I tend'1 em Ne Pdmsry".' °: ..•• <br /> Exporter;,candy(ha(Aie cvnlenli o(OOs,conslgorn"tconform lb the terms of the aRadhard EPAAcknarAidgmanl M Consent . <br /> I.Wrfif 0ai-ihevaeieilmimimdon stitemenlidanlfiedin de CFR 262.27(a)(Ill am a lasgequiernif neralar)or(b)'O(Iamasmell Quandygeherator)Is true: t' <br /> GenemPpxady.Nam�enCP'G✓ (�/Sr '`'f()GL�IUI9greWre:..,. ' Month <br /> Ray <br /> sagr. <br /> : <br /> 14 h .. <br /> 16.InIems6onab6hipmenls • ' <br /> • ❑Impod 6i U.S. ❑EYpod,from U.S. � � Padafgn6,y(e:uT: <br /> Treneportar signature Itmie%Ps11¢.odY) Oole la'nArlg lS,:;: ' <br /> of 17.TranspsrarAw6roam'nlo,ReteiploFMaterials <br /> TmnspMerlfKMl PT <br /> fYVgma/1 Signature Month Day year <br /> lianaportir2Prjnled7Typed Name 7 SignatureMonth Day.., Yea{ <br /> f <br /> 18.Discmpanrry .. . . <br /> 183.Dlsempancy Indication Spero .❑9aandry ❑`.IYpB ❑RB6tlum <br /> ❑Pediel Rejection '❑FNI RefA[iian <br /> Manifeal Relemnce Number: <br /> 1Bb.Allemate Fedli(y(or Generator) U.S.EPAID Number ' <br /> U <br /> FaclArys Fhotml ' <br /> & igraWre olAllamete Fedfily(or Genaretir) 10th Day -.YBBf <br /> � 9 <br /> r7HaamOaa Waste Report ermsml Malfted Codes Cr.e.•edasforhaiardou waste hesbnen6 disposal,andrerydin s ;tims) ' 'r• <br /> �A-1 L' <br /> ') 20.Designated Facility 0Wner or Operator.Cemilradan of recalptof haza'(daus maledals mvemdby Ne qnttexts leanded in ltem.18a Y ' <br /> 111 Pdnl d/Typed Name N r•:•••• " <br /> EPA Form 8700-22(Rev.3-051 Previopsetl8ionsareotisolete. fRAAfSPOIiTER'S COPY <br /> ._I 'J..LL'C Li,1 'DAI Air I :wrnn n -thun-ih awa.n• II r n7 •r <br />