Laserfiche WebLink
g3i� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> 005523045 S KS <br /> Please pint or type.(Farm designed for use on elge(12-1 typewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORMHAZARDOUS i.GarerebrlDNumbx 7...v,.`wtV,,,..,;.,.,_. 2Paggld 3.EmmgersyResnWlsaPborw.. a'F1OtJJCN3O45 SKS <br /> WASTE MANIFEST I,J <br /> s.Genmmde Name and MaNiy Address _ Genmatofs Site Address lir darmall man maibng atldreaal <br /> GemerarMs Phone: - <br /> 6.Trenmmnapl CumpanyName U.S.EPA ID Number <br /> T.Tmmq oda 2 ComWyName US,EPA ID Number <br /> 8.Deaipre4EIi Name and Site Address US.EM to Number <br /> Fri Prove - <br /> ga. SO.US.DOT Dai(irol gProper enter,Name,Harvard Clans.ID NInMm, lo.CaMtiMrt 11.Tme1 12.and 18.treats Cookie <br /> NA1 aMPa MNg GouP l8anY1) Np. Type Owntlry Need, <br /> rc t NON RCRG HFZARDOUS 41FSTE,LIGIJIC <br /> ETHYLENE GLYCOL SOLUTION (LESS THAN 50X) <br /> z 2. <br /> W <br /> 14 <br /> W <br /> 3. <br /> 14.Spend Handing laftembons SM Additional leformarbon <br /> -gin EMERGENCY 1F1—F.00-458—:760 (SK / TITI <br /> c q^. 1 -n pr.rrrP I r <br /> 15. GENERATOR'SrOFFEROWSCERTIFM:ATXIN: Ibaeby tledaamellM1eanlanSdYms mnsignme tare NllyaM arruretely tlesmbed above by me Draper sbipgrg name,ab ere dessBatl.Daokagad, <br /> marketl aM IabeleNpdaMed,aMare inall reslaeds N pmpmrondNm MtrerepMaavroing b apptiade inmmationelaM national govemmenml reguletiora.lf sxpoNsbipmeMeM)aroma Pmrery <br /> Ime*tIceN1y NMVumntanSotNsconeynmentii40 Cb Mr(., mea6aM1etl EPAAcknowletlgmentd tat <br /> 1ror8N mdme wore minimization atatsasnlitlenMwtl into 40CMr(., emalary09uantiry gmemtad ar@) ' IquarMygenaretaf islea, <br /> Gooch' IMS Prawyped Npme SgreWre Monm NY Year <br /> 7-1110 <br /> F 18.treatment neonate; ImpM bU S. <br /> Ll Even man US. demrylertt <br /> Trnapona dglraftre(@r exports only): 11terni: <br /> M. 17.Trani maaMcdryrem ofF emd Mani <br /> Tien iPAemNTypad Name w SlgnaNreA btonm Day Yam <br /> Z <br /> Trateporear,reammi,eauream Warne L11 deem MYear <br /> 1 18.DbDzepenay <br /> 18 Mm ap glndatio Spero El ami ❑Type El Food. ❑Pareal Rejmaon ❑FUIlleeslbn <br /> Mariresifldererae Wnnbm <br /> IBb.Plremata Fadliry for Gerorebd US,EPAIO NIvrMr <br /> J <br /> U <br /> FaMTy's Pnome: <br /> w 180.9igmime orNtemate FaalBy for Nei Amnm NY Year <br /> h19.Hv doua Wash Repots Nsnegemenl MCNod Codea(ra.,mtles fwhareNOlawasre treaNanl.dbproel,aMreglYp eyelemel <br /> 1 2. 3 a. <br /> 20.oesiyleled Faglity Owrrtrrc Opm ,Cxb Umdre oOhma smaraialsmmWbyftmant eWtas Merlin ImmlM <br /> 1 m YPetme (lSignawn 0, Year, <br /> EPNFonojll -2,2jWk[)5) Previouseditunsareoobsolere. DESIGNATBDtWLITY TO DESTINATION STATE(IF REQUIRED) <br />