Laserfiche WebLink
i <br /> Please paint or hPe. S <br /> FonnApproved.OMBNo.205D4GN <br /> UNIFORM HAZARDOUS 1.feneralaiD Number 2 Page 1 of 13.Emergemcy Respase Pbw 4 DOW Tfwft Numbs <br /> WASTE MANIFEST CA2990090002 1 1925423-4= 019445588' JJ K <br /> 5.Gerwabfs Name and Mal Address Generabre 5%Address(11 MbM R I=md"KiMats) <br /> L�+tlmm rr,�« M Lab SM 3W 40�d U6 WEA Lavon ee U„a,,m Lab S t9r 300 an WW d V5 WV l <br /> PAL 80 M/L-786 UNN MM CA SIMI Ctlrral Fbbw ib�dTtrary G 96376 <br /> GeneraWs Phow 925-422-19S ATTR <br /> 6.TrargwWr i Company Name U.S.EPA ID Number <br /> TI+S "Maw ThIfflkCa mawma n <br /> T.Tramsporter 2 Company Name U.S.EPA ID Number <br /> B.DesOuded Fadlty Name and She Address US.EPA ID Nmrber <br /> OAn Hub=Cdh%L LSC 3763 H OM X71 Ctoft LA 71417 EA=10%791 <br /> Facill t Phone: <br /> 9a. 9b.U.S.DOT Des*m(eft PMW 9409 Name.Hazard Oak ID Number, 19.Canrakrers 11.Trial 12.Ueit 13 1Maate C.adas <br /> HM and PKkkV�P{B amyl) Na Type am* 1M m. <br /> o t Wim,CB Mme„RNM W=6 CRM D[ENS 1711 DOM3806-1 1 OF m P Dom DOOR <br /> 331 <br /> 2. CUWC%^wIld VIM ORM_D[ENO 2721 Dor01=62 1 DF 7 p Dona Door <br /> P52 <br /> 3. <br /> 4. <br /> 14.Spatial Handling Irahudm and Adffifim l Inhxmanon <br /> EnlN oNM .RWW92"23-�Cmitnt num U.M.EmlarWM Dom. Lid A oaXWL S*Doc ft& ,T 9 <br /> 15. GENERATOR'SKffERO"CERTIFICATION:I hereby dedere nrat the wrderda d this aaWp..mm are tiny and aoarrately desaied above by the proper ddppkq name,erd are dawned,pad®gad. <br /> marked end landedfpla=ded,and are in an mvtpeds in proper aondnan for a¢nrdeq b appiwhle Intermallonalmd mandril gaymnmetW regrdstlarra.Nexportt4wat and I am rhe Prkrrary <br /> Exporter,I oediy tlrd pro aw4enh d Crb omWgnmerd cc I toBre tenrrs d the aBaehed EPAAdmmudpod or Coni mL <br /> I oerny that ftwade minkniratkn aEataarmt Iden9{fad ki 49 CFR 282.27(a)pr I an a large gran*gawaW ar(b)trI am a amen t, <br /> Generabrs1011m&s PrWmYTyped Name 5lgnahrre Yew <br /> Scott A.Graham on behalf of NIDA JJA 1 /7 Lt <br /> I&Intemabmd sm"enls ❑kw b U.S. ❑Expdtfmm U.S. Poatorerdryredt <br /> ? Trarapdter siprrahae(gar exparts onlyk Dale bavkrg U.S.: <br /> a 1T.TransportarAd mMedgrrrerd of Recut of Males <br /> Trarnpolter 1 Pdnted/fyped Name Sign Akft Day Ulm R l4gnaer- I -% 2- f <br /> TWL2 Signahxa Day Y <br /> 18.Oisueparxy <br /> 1 Ba Discrepancy Irdiration Spare El ❑� ❑Realtime ❑Padfal Re(ecUan El FW Re)edlon <br /> Man"Rebtawe Number: <br /> 1W Allemate Fealty(a Generator) U.S.EPA ID Number <br /> V <br /> U. FadWs?hane: <br /> 18c mofmarrrawFaau(OfGenerdd mart Day Year <br /> H19.Hazardous Wasle Repad Management WOW Codes a.&,oades for hw loos waste treatment.6aposal,and MCI&V ) <br /> 17 Ui 1 2 kAl <br /> 3, 4. <br /> Desq/nafed'�/FacRly Owner ar Operator:ChwwuWbythe*tlp0asrledlnIleTfBa <br /> Rkfdqypad Name <br /> EPA rml 6700.22 Rev.f2•f7) Previaas edldor>s:Be DESIGNATED F M EPA's B� IF SYSTEM <br />