Laserfiche WebLink
�r' | <br /> . ^ "low <br /> lumber <br /> ency Response Phone <br /> NON-HAZ4001. Number 4.Waste Tracking I <br /> 5,Generator's Name and Mailing Address Generator's Site Address of different than mailing address) <br /> Generaloes.Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> || <br /> / <br /> | <br /> | <br /> | <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> |U."30 K- 1611h strod <br /> |� <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 2 2— <br /> ! <br /> Facility's Phone: <br /> 10.0onlainers 11.Total IP-unit <br /> 9.Waste Shipping Name and Description No. Type Quantity WIJVoI- <br /> Cr <br /> RIM <br /> 2. <br /> 4. <br /> 13.Special Handling Instructions and Additional Information <br /> 14,GEN ERATOR'SIOFFEROR'S CERTIFICATION:I hereby dedare that the contents of this oDnsignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeted[placarded,and are in all respects In proper condiflon for transport according to applicable international and national governmental regulations. <br /> Teneratoes/Offeror's Printed/Typed Nar�o. Signature Month Day Year <br /> -1 15.International Shipments <br /> 1:1 Import 1.U.& Export from U.S. Port of entry/e <br /> Transporter Signature(for exports only): Date leaving U.S.: <br /> cc 16.Transporter Ack(wirledgment of Receipt of Materials <br /> ETransporter I PtintedrTyped Name Signature h Day Year <br /> 0 44 <br /> Transporter 2 Printed/Typed Name Signature Month Day Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> Quantity Type El Residue El Partial Rejection Full RojLctin <br /> Manifest,l3aference Number <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> IL Facility's Phone: <br /> 0 Year <br /> uj 17C.Signature of Alternate radlity(or Generator) Month Day <br /> 19.Designated Facility Owner or Operator:Codification of mcolpt of materials covered by the manifest except as note-d In Item 170 Month Day Year <br /> Printed/Typed Narm Signature <br /> � <br /> � <br /> ' <br /> � <br /> � . <br /> � i <br /> � <br /> � ! <br />