Laserfiche WebLink
kyung park 209 835 3731 pA3 <br /> BILL DIN(WMANIFEST 1.Shippers LIS EPA ID No.(I p Icalol DO 2.paw I <br /> or <br /> 3.Stappera Name and 14]ling Addiveir <br /> 5.Transporter I Compan Nam US EPA ID Number. a.7ransponer's a <br /> 7.Transporter 2Ccmjx,an Name 81 US EPA 10 Nuchlow a.Transporters Phone <br /> 9-Designated Facility Nor a and Site Address 10 US EPA U)Number C.Faclifty's Phone <br /> C4 qtR� � I t(T 93 <br /> 11.Shipping Name and D scription 12.(1 Inem 13. 177 <br /> Total Vol <br /> r—H—M7 No, Type Quantity vftvol <br /> a. <br /> WINV)w cc— to <br /> IN <br /> I C. <br /> P <br /> P <br /> E <br /> R y- <br /> 15.Special Handingvi ttion and Additional Information <br /> 'T <br /> 116MUSDOTHAZARD015 MATERIALS SHIPPER-SCERTIFICATION: ud ere in'tow <br /> ftrdedrryped Name M2401 Day Year <br /> 15b.KQN-REGULATEDI 41PPERSCERTIFICATION: on,not 9.*10 fildi noguislors for TramParbuicto I D[q1111. <br /> P " '�' tbv <br /> id Name KaHhY <br /> rr fy <br /> R 17.Trarnsport6ir I Ailtriditt! dgei Receipt of Materials <br /> A <br /> !for'stedfrywd Mari Signature <br /> P 7or <br /> 0 'Is.Tinumporter i-Aiclanioni. dgemard or Receipt d Wanda, <br /> It <br /> 7 . Printectrrypedj Name Sigretlae htonih DW yi. <br /> E <br /> It <br /> 119-DiscrepancyIndication ;paw <br /> F <br /> A <br /> C <br /> I <br /> L20.Facility Owner or Ops Codification of receipt of materials covered tyyd&form except as noted IltM 19. <br /> 11 <br /> T <br /> Y Forintedl Nam, Signature Momh D" year <br />