Laserfiche WebLink
'MOON PAM Of 1yp•, o'.crel.9"o roe use on• • p pew. <br /> I Generator's US EPA ID No. Manifest Document No. 2. Page 1 is"I oqu;a the shaded:teas <br /> UNIFORM HAZARDOUS �/ „--T O r. 1 it not required by fcdvol low• <br /> WASTE MANIFEST <br /> 1. Generator's Name and Mailing Address J�SorS(iss�0oci�m' r:+�ay�aw�;y¢}��' <br /> �1 LA �G� � . . _. .,.�:'Y.� x.9:26=9`� •�0•.'� � <br />! '^ �.,'�) � �t - 6.esrri+ir�Geiw.was'.,la�?=y;,-_�r .._._..i a•.. -,�i.firV::. <br /> s. Generator's PhoMAot <br /> S. Transporter 1 Company Name A. US EPA 10 NumberC"�S1dt Tia_nspo'e"' i <br /> " t ' I D t b D'Tccrop�Aa�i Phones <br /> r , Tronsporter 2 Company Name S. US EPA 10 Number E<SkzTaTst>+ts{wiN/sl ;�+; _ "=•`s a',: <br /> 4 '%`"_:�lika'1`;per,►ii•t�?-...t: ;::i.•.:.-'•`,`:<;-•�i:.'�•r•_.:5,;.,.:F•-.;:� <br /> V TodisipoMs's: L i y C;•_Yt s,, C:- :, ',. <br /> L <br /> Z 9 �ignt»ad�gciiis� L+o and Si/e <br /> deft t� t0. US EPA 10 Number <br /> ��v,,+ t � _ .+,• .r.• cru <br /> V <br /> Z 11. US OOT Des<ripfion(indudnq Proper Sh:ppinq Name,Haxord Clms,and 10 Number) No. T Cluanfi Wt/Vol L.Wodi•NrtnFiea''"' <br /> s"% <br /> 3 G �/ EPA/Othai =.C: <br /> v R EPA�Otliet <br /> �� `.: .s'.t Fes» •ts is-Nrdi <br /> T <br /> co r;. t r. Tr.•t <br /> O _FFI f Olfri4di t'a"y�J;? r <br /> uj <br /> V � Ot$er r x :ayi <br /> W <br /> O <br /> W — <br /> ce X. <br /> J f �+ <br />' Q ✓t <br /> Q13. Special Handling Instructions and Additional Information <br /> Q <br /> Z <br /> W <br /> 2 <br /> f- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents oI the consignment are fully and accurately described above by proper shipp;nq Home and ate classified, ` <br /> J pocked,marked,and labeled,and ore in aR res In proper condition for transport 6 hi hw according to a licable federal,state and international lows. <br /> U P Pi's• P P P Y 9 aY ^V PP� <br /> It I am a large quantity generator, I certify that 1 hove a program in place to reduc#Ffog', <br /> nd toxicity of waste generated le the degree I have deform nod to be f <br /> =1 economic° practicable and that I have selected the RY p practicable method el Med or dispo urrently o"ilobte to me which minimizes the present and futureNthreat to human health and the environment;OR,4 1 am a small quantity goner de a good A effort to minimize my wase generation and soled rho best <br /> a waste mono merit method that is aooiioble to me and thus I can afford. <br /> o Printed/Ty ed Nome Sig fur Mon Day <br /> ?- r <br /> V T G - <br /> Z t 17. Transporter i Acknowled emeni of Receipt of Materials <br /> W e <br /> NPrint* ome. Sign re <br /> Qr s `/JJ <br /> W <br /> a 18. Tronsporter 2 Acknowled ement of Receipt of Materials <br /> W ; Printed/Tvoed Nome Signa re I Month Day Year <br /> O it <br /> IW 19. Discrepancy Indicotion Space <br /> Q f <br /> V A <br /> Z C <br /> I <br /> t <br /> I 10. Facility Owner or Operator Certification of recei f of hozordous materials covered by tWmaniFe"J:aqiKa/Acf*d;n1t&-Q197 <br /> T Printed ype Nome ( $ignaNre I Month Day Year <br /> .�• 71 <br /> DO NOT WR6f BELEI<TkLINE. ` <br /> re: TSCA <br /> orsc 8022A (7/921 ;0. 3r.00 ^c•r.. :•••- <br /> EPA 8700-22 <br />