Laserfiche WebLink
08{02{2018 10;36 <br />(FAX) P,049/065 <br />NON-HAZARD011$ I. Uenaralor ID Number 2, Page 1 of 9, Emergericy Response Phone 4 Weak Tneking Number r <br />WASTE MANIFEST AQP?. 011 -`ELS: J <br />6 <br />-�-de++n'�eAAntar9 Nemsand MatI7 Add/ress ((// ((((((���� 001rgata s Site Address (M cfiHsrard than m addreay) <br />J.r•i! U {% 4I�r G. N'(Gl :'��{Jr:-O� j .ly�'I� Vr pc" Yr <br />Oenrreta a Phone: 7 - 1 � c <br />6, Trenspoi* t Company Name U.S. FPA ID Number <br />7. Transporter 2,tbrnMny Name U,S. EPA ID Nwrteyr r 7 r <br />8. Dealp *W Faddly Name and take Address U.B. EPA ID Number <br />*;COLO UY <br />4 Gil 7 fr'��e 5"di3.:-4 , ...1r.� <br />.a <br />Fed 's Phone:. 11707 67Z -iri 10 <br />A. Waste Shlppfng Name and DeacripUcn <br />cc 1, ' ` i f <br />/V a v7 r/ C+ .C�r C7 U u Q GA t �f7 f �C t� CA <br />t9. speelal Hsrdlitg IMAftweons and Addllonal Information <br />10. C°ntsinen <br />11. Total fe UnN <br />No. <br />Type <br />Quent ty WtNai <br />Month <br />Day <br />1b. Irrlemetionol SMpmenta I—I <br />lJ Import to U.S. <br />HFPL�s <br />IL 4ENEIiATOR'SAIFFERDR 9 CERTIFICATION; I hereby declare that Ilia contents of ihfs oonslgnmeni ars fully and taountety daeodbed above by The proper ahipping name, and me ciesaifW, packaged, <br />marked and labetedlpfecarded, and aro fn all raspocla in proper condition for transport aaaordinp to amliicehla InlernaftW 11 natlonel govemmentd regula Dons, <br />(ieneretorel0(Ierors PdmeTypedrNeme <br />Stgnelu �y� �' <br />Ma1M Cay Year <br />Month <br />Day <br />1b. Irrlemetionol SMpmenta I—I <br />lJ Import to U.S. <br />❑ Export Iran U.S, Pon <br />Trarworlar Sianew r axporta oniv); <br />of entryredl: <br />Date Jeaft U.S.; <br />14 Trarrsponer.Admo rledgmsnl of PWW of Materials <br />Trenaponer 1 P n ed NameSlgna(uref <br />✓ r/ <br />Monih Ds Year <br />Transporter 2 PanwTyped Name <br />i <br />SI un <br />Month Day Year <br />1 <br />17. pisarowey <br />17a. INwrol enoy Indlmtion Spam LI U" . <br />IJ <br />❑ Type ❑ p"Id. LI Paha( pe('ion <br />❑ RA %J#don <br />176, Alternate Fadlhy (or (ienarelor) <br />Manifest Reference Number, <br />U.d EPA ID Number <br />i <br />6,.• j <br />Fact's Phone: <br />f <br />A <br />17c. Slgneh,re of Altemata Facility (or Generator) <br />Month Day Year <br />18. Dealgnaled Facilry Ownor or Operator. Co Mcatlon of receipt of maloodis oovired by the mantlest w=pl as noted In Item 17e <br />Name .fr 9fgntlun ,�� <br />SI 0 n e ♦rn� in_.. -, <br />r <br />Yser <br />Month <br />Day <br />