Laserfiche WebLink
UT Si C .. 0,13- 7 711 , 1.0 4.3, <br />;:— —A num ij. WWLCA'%Q <br />urease <br />print or type. p-orm assignea <br />UNIFORM HAZARDOUS <br />for use on eirus jiz-p=j rypo--j <br />1 1, C'Onerstor 10 Number <br />2. Pop I of I Emergency ftsponse Phone <br />t Man Trucking Number <br />JJK <br />WASTE MANIFEST <br />L <br />000122912 <br />cww*ft Site Address M different then maiiiing address) <br />�g.s�.i <br />a - <br />Goneratcres dikst P0 H4 g..J j, c4 dwr, C* <br />6, Transporter I Camp" Name U.S. EFA I~ber <br />I CA �-O &00 l3 <br />JnO6414 S4Pr0jCe—.S <br />7.7 2 Company Name U.S. EPA ID Number <br />Er -QV VDVk%AAe4'�Va k'6' ilkt UAL. <br />8. Dmp at qne and Site Ad U.S.EPAIDNumber ft A� <br />a r'o. <br />30 i <br />5= <br />Phorre.-,% 0 0 <br />9(9 <br />qa. <br />9b. U.S. DOT Description pndWhg Proper Shipping Name. Hazard Class, 10 Number. <br />1a. Containers <br />11. Toho <br />12. Unit <br />13. Waste Codes <br />NO. <br />Type <br />HM <br />and Pa*ing Group (if mry)) <br />Q=* <br />WLNbL <br />0 Sol i'd <br />0 If <br />jo-em- <br />too <br />P <br />.223 <br />3. <br />4, <br />�418 I Nandlipq ln*uftns andA Inflarmalon <br />I ;V43(vul ST6 q <br />it <br />15. GENERATOR'SMFFERORIZ V-10111'"11ON: I hereby dedwe that thazonlents of this consignment are fully and accurately described above by the proper shipping mine, and are classified, packaged, <br />marked and Isbeleftlecarded, and are in all respects in proper condition for transport according to applicable hernationaland rational govemmental regulatioc If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment corrimm b the terms of the attached EPAAdavowiedgmient of Consent. <br />I cortily that the waste minimization statement Identified in 40 CFR 26227(a) (111 am a large quantity gimeratow) or (b) (d I am a small quantity generator) is true. <br />Generstoe s Prin%ffyped Name signature Month Day Year <br />10F11(a 1n� <br />r j <br />16. international Sbipmentse Elhnwtu,dv FIExport from u. s. L,' el PoAt'of entry/exit <br />M. <br />Transporter signature (ice exports onl# Date hurving U.&: <br />Ce <br />us <br />17. TransporterAdomviedgmont of ReoW of Materials <br />Transpo I PrtntedrryW NameSignature Morth on year <br />CAN <br />YQ&&J 116 nc <br />—2P&*xvTy)ed <br />Trarworter NO. alf"I'my—flA . . ................... Month Day r <br />= 6V <br />- VA <br />18. Discrepancy <br />18a. Discrepancy Indication Space P Quantity nTypa,❑❑Partial Re*ft 0 Full Refection <br />Manifest Reference Number. ' <br />16b. Abmate Faddy (or Generator) U.S. EPA ID Number' <br />ti <br />Faclilys Phone: <br />18c. Signature ofAltemate Facility (or Generator) <br />Month Day Year <br />19. Hazardous Waste Report Management Method Codes (i.e., coda for hazardous waste arealme% clisposa, and recirding, sys" <br />LU <br />0'* <br />AH <br />3. <br />1-1 <br />20, Designated Owner or Operator Certkation of recatiot of hazardous materials covered by the manifad in Rem 1* - <br />PrtniadJl <br />ITI <br />EPA <br />Form 8700-22 iRev. 3-051 Previous editions <br />are olosdate. A-rc tic ociNiiinciri% <br />10429.1039 <br />