Laserfiche WebLink
NO"A7ARDOUS 1.Generator ID Number 2.Page._ fm ongency Responses Phone A.Weate Tracking Number <br /> WASTE MANIFEST aT}n,'S1CF' <br /> i•:!, <br /> S.Ganerafors Name and Wang Address Seremds She Address(II dWerenl then noting address) <br /> FrniR#•n S:al?5;1d3�:Iutl '1 •d l.-:•":P:c'Sayp . <br /> Chante ii:, 3i2-^ <br /> G Transporter 1 Compenp Name - U.S.EPA ID Number <br /> DILLPPC: Est:!Ir.iil¢i.!F111?'i-iEP-.F;c> , C6091y75dici: <br /> ?T-moipenel. Caip'airy Norma {. :;•• .�`:•v rs - -••'+e e, U.S.EPR®.Nurni <br /> 8,Designated FandelyName and 9W Address US EFA' <br /> rnue.81 -Alp. ?.Sr91•.r:N-a. F•,P,:l zRIMi <br /> y <br /> Fac#es Phare: 71N 4r.064 —._- <br /> 10.Containers It Tolal�"' 12 Una <br /> 9.Waste Shipping Name and DesdPlbn _ pro, Type Duedly',-i. 'YylNd. <br /> I, iabh, i1,1 11 Frl(Xi�-"i sire 7i.Lli rR111- Airl:';E'l — <br /> ¢ �!wa' <br /> ri Y.ri'fif,..c0--11, .r <br /> W 2 <br /> 9. <br /> 7S•Speulal Handling Inslrucem,e and Additionallnlormalion <br /> . j u <br /> a� <br /> 11.GENERATOWSOFFEROR'S CERTIFICATION:I hereby declare Nal the omleds of this coneigmerm are lull and accurately described above by me proper stepping nade;and Bre ed,packaged, <br /> merrisuid arbsch Npfaraded,and we In at respects in proper 00deon for transport accosting or Applicable'ImernaBmel and nauoral gmemmental regllaeons, M' Day Veer. <br /> Gitoerelor'01femr.p"talurTlped Name„ - Sgneture/ 1 I ` <br /> J 15.Imamal at Shipmenrc ❑ Pon of satry <br /> ❑Espddhorn LLS. :• lolN: <br /> - <br /> Import to U.S. l.,i - <br /> Transporter Sl naWre Wrexports ont : Ode laavi U.S <br /> ¢ 18,Transporter Ack.noeledgment of Receipt of Materials <br /> Yeer <br /> �. Traispdner1 Pdn%dfryped Name Nre - Esc.;. - 7 <br /> -MdnN Day Year <br /> Transporter 2 PdnWNTyped Name .. 49"AWm <br /> I7,Disueperwy .. ��l� <br /> 171 glapepaM Indication Spate II--�t� ❑T .:r_❑pkeraie. LfPAI¶.11 fi rethon ❑Fu�Pc;eclien <br /> y DQuenty Type lb <br /> MaNlestelarence Number.� �-. `---- <br /> Z <br /> Ih.A annale Facifiy(a Generator) UFS. ,dD uymoer <br /> U <br /> Xa Facifil Phone: I "01 Day Yeo, <br /> 'W 17c Signature of Alternate Facllay(or Generator) <br /> z <br /> u <br /> N <br /> 18.Designated Fadky b.rimgl or Operamr.Cerfacatlon of mcelpl of materials covered by the mard(est export as rated h hem 17e` Moran Day '!,ear <br /> PnnWNTyped Name �T Signature — - <br /> Jt) :3 _ I G I/��i� <br /> TRANSPORTER 91 <br /> 169-BLC-0 5 11977(Rev.9109) ,, - :UPI.b�81� <br /> I n <br />