Laserfiche WebLink
08"'15/2013 14:20 209529 S <br /> BO'IETT WAREHOUSE PAGE 07/13 <br /> �ae¢tac axer t�. + vat x- �;� f�. s 95,551 2-04'- .ithip 20 day's.*a <br /> N Rail asst. <br /> ' Form Approved.OMB No-2054 0039 <br /> ,please print or type,:(Forin designed for 660 on elite(12 itch oawriter.) a-Nasus Wk tking Number <br /> 1 Gsn rutorlD:Numutr �, ?qe l of.(3.F_merggrsc 6egpe ePhone „� <br /> UNIFORMHAZARDOU5 ,/� I. - fav-Y�� p fi7 JJK <br /> WASTE MRfsiFEST / j,� `,�.�e�,�" ` t � �- <br /> 5.Generator's Name and t1a ling AtldteSs �e ra s site Address If different hen maB�n 3ddrs) <br /> 3 - RECE <br /> Generators Phrot?: U.S.EPA ID Number <br /> e.Transporter 1 Company Name "s <br /> EverC:t36'ii i:rl+`ia.d3t:d'f8t7Bltiwz U.S.EPAIDNumber <br /> 7•Trtn_:pprler nompany Nsme <br /> 8:Das aatcc!Facility Name and SIte:Adress_= _. ,.�.. - <br /> u <br /> _. ... um <br /> . U.S. LF+i DE -NT <br /> Oil..Inc, CAD98OW41-8. <br /> tYE253DSmiIrhAw0, <br /> Paclfity's Phone: ri'f =P C°Y 41►L't? <br /> 9b.U.S.DOT Description(Indudhrg Proper Shipping Name.Hazard Class,ID Number, 10.Cp ttau ars 19.Tcisl wt Unit 1,i. Codes, <br /> HM• 2nd Packing Group(If any)) No, Type <br /> r <br /> 1-AhAVIRC" Z' <br /> ` I t <br /> 4- <br /> i I <br /> t�pecialF:andling'InstruC�OnSantlAddlUOnallnformation . ��_•�+�'�"����r� r � ____ ,.- _ <br /> Z5. GENERA70R'$10FFEROR'S CERTIFICATION:1 h¢let7y declare that the mntenm of tis consrc�nmerd a!e fully and accurately dasedbed above by the proper shippinc Hama,and are classified,packaged, <br /> marked and labeled/placarded,arid are in all respects in.proper conditicnfur transperta=rdlnn io applicable international and tlatlonal govemmental regulations.If export Shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to lb--terms of the s-ached EPAAcknowiedgment of Consent <br /> certify that the waste minimization St+ternent.Identified in 40 CFR 26227(a)(f I am a lame quantity generator)or(b)(if}am a small quantltY 9enarafnr,'s true. Month Day Year <br /> Getter to sfOfferor'SPrinted(CypedName z 9ignatu2 t <br /> 11n1emnticnsl6hlpmerna rr�� <br /> h ft U.g. Pa t Of enirylext.. <br /> .' I:.,:Impart to U.S. — Oats leavin U.S.: <br /> nsnsporter signotUre(for exports only): <br /> IX w 17.TransportarAcknowlerdgmentofReceipt ofMaterials J Month Day Year <br /> ~ ian,po 1 PrintelUTypetl Name f p�� / ���Z <br /> t9�2� ,/ l�"'•°`'� ! �!�"jtl���� Month 4ay Year • <br /> Transporter 2 PrintedlTYpad Name Sigra wa'j <br /> CD <br /> d <br /> Is.Discrepancy <br /> Res(due ❑ ❑Full Relecticn <br /> 188.Discrepzincy Gtdtoation Specs. � Qua:tUry �TY�: P.-wl Roaction - <br /> .:. ._.: _.:._. c ,_ .. ..... ........ . :. fvt�,nifesfRefer�tr�•Number,'. . .. ,. <br /> U.S.EPA ID Number <br /> 1 OD,Aitemete Facility(or Gencratof) - <br /> J <br /> Facility's Phone: Month Day Year <br /> Qu 1BC..Signature ofAttemata Facility or sneretor} <br /> 19.Hazardous Waste Report Mena amant MBUnxI Cedes(i.e,codes far hazardcu Virile tle' =rn aspcsal,and ret yraing s Y'atemn <br /> a. <br /> i1. <br /> 2 3- <br /> 20.Deslgnaled Far1'rty Owner(w 0perstor:Cartnmtion of receipt of haZarlsaus mstsraisa.!erd by tti marlifest exoept as noldd in(tem 1%, monL'-i Day. �r <br /> gnemra <br /> rimedfTYPed Name U � � (i f�f �;.t� .;12 . <br /> DESIGNATED <br /> EPA Form 8740722(Rev,,5-05) Pre+rous edt6ons are ubsoleta- <br /> FACILITY TO Gin!dE�'TOR <br />