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Guia de StrongPakT SobreelManejodeMaterialesPotentcialmente The StrongPak TM Guide to Potentially Hazardous Material Management <br />Reviewing a Manifest Before Signing <br />Verify this <br />Is your Revision de un Manifiesto <br />Staples <br />Location& Verify this is your <br />Contact Info <br />Transporter <br />Name &EPAID <br />(make certain <br />there is an entry) <br />AnTTX"or"RQ" <br />indicates there is <br />DOT Hazardous <br />Material <br />Proper <br />Shipping <br />Description <br />Area <br />(must be <br />filled in) <br />Transporter <br />Name & <br />Signature <br />(Required prior <br />to departure <br />from your store) <br />Store EPA ID # <br />Plaasa orinl nr lvrs. (F�rm dasinnM fir hr_ae nn slits fl7ali,nhl lanwwdlar lI Pnrm Annmvnd. nMR Nn. 71FAX134 <br />UNIFORM NAZARDOUS 1. C�eM1maNf lD Number <br />2, Page 1M 1, Emmgancy Reapsnse From <br />ITradribar <br />WASTE MANIFEST M V 4 1 3 2 4 4, 1 4 6 <br />, �} - <br />0 60'R841 JJK <br />5, Garembrs Name and Mating Addfat Exemplar 17468 rotors sda Add—(t diffeiant than meNlng ac&r ) <br />Attention: Gary Haywood 810 East St <br />Pittsfield, MA 01201 <br />(413] 2441146 <br />GeneratI Ph.. <br />6. Transipwer 1 Company Name us. EFA CO wumroer <br />Steri ale Smcialty waste Solutions Inc M N S 0 0 0 1 0 0 9 2 4 <br />7. Tmpspmmr 2 Company Name U.S. EFA 10 Number <br />8. Designated Fatuity Name and Sb Addrass U.S. EPAID Number <br />Acme Recycling &Disposal <br />L <br />6520 Ivey Lane <br />Atlanta, GA 30018 <br />Fadi ePeana, (678} 424-7215 GAD 0 0 0 1 2 8 9 7 6 <br />Ba. <br />ab.I�S.IDwriplgn(fodutling PmperSNPPbhg Name, Hamm Gess, ID Numb.,, Co <br />11.YoAi <br />12. Unit <br />13. Waste Cedes <br />HM <br />and P&I Oraup(IIIII) <br />Type <br />CpendlY <br />WLNI <br />1 <br />fl0 <br />,. <br />UN1950, Waste Aerosols, [flammable] 2.1, PG, ERG-126Z4C__ <br />I F W-LZA- <br />P <br />UN1993, Waste Flammable liquids, n.o.s. (ethano' .et <br />X <br />PG II, ERG -128 <br />3. <br />UN1760, Waste Corrosive liquids, S. (S di"AaAalte, <br />X <br />sodium silicate) 8, PG II, ERG -1 <br />4. <br />Non -Hazardous, Non -Regulate <br />!!v <br />I nn2i <br />CIF 00082 <br />12 <br />1 <br />14. spaol I Handling Inalnwbafs and Additwm3 lntpmmtipn <br />1.5194 <br />2.5192 <br />3.5195 <br />4. 51 <br />15. GENERATOR'SIOFFERORS CERTIFICATION: I hembydeelam That the eumeI tliemnaignmenlara (ullyane a-rately described III the proper shipping name, andaredassihed. paeAagad, <br />mediad end labelaw0acamed, and am in all haspecm i, proper emem, for Iranapon accprtling to applicable inlarrundnal and nalienal govemrenal mgulatore, d mporl Shipment Wd I am the 1`11mary <br />Expmkr, I peNty 1ha[ the car4erfEs pl this conssnmem ewdprm fi the terms ai"fe atached EPAAcknpwledgment of Consent. <br />i.ri,yth2tme westeminhnGalion strhn mRidentbad In 40 UR 262.27(x) R tam a large Wrntlly g pr) (b)l'dl am J4.11 quangfy g.ffm J l3 true, <br />C-erhenrcarslOr`erara Prinledflyped Name 3A Momlt Dai liber <br />F tB lruemat 5h1 Ls ❑Impel mU.SExport fmm D.. Pallef'sary1mt <br />? Transpp*' signalamIII 'TdI poly): Osla l—IN 115_ <br />fY ,Y. YmrrspprEer Acbrmwiatlgmentot Receylal Mal&dm <br />Tmfmppderi Pdn Nemo 51 Morah DaY Year <br />a <br />Q Trensporkr2 PdnaedfTyped naNm Monro Day Year <br />K <br />16. Discrepanry <br />16a.cauraimwylndkato1Specs ❑ " ❑Type ❑Residue ❑POrdal Raj ,. LJ Fall R(y'edbn <br />Manifea3 Reference Number: <br />18b. Ahemate Fadlity (or &mraldr) u.5.61 Number <br />LL FaeiVa Phone, <br />w IBL sarialumo ANernate Fadhy(m Generetal <br />Monty Day Peer <br />H19, Hezialm Waste Pedant Mamig—I Method CadeeQ.e., mdse for hmmdm waste lmalmnnl, dlsplW, andrecycangsyslems) <br />1, <br />.ilasyreted FedY'ry 04ncerorror Cpemgr:Cert6ratlurarnah�lafhemdp,rlrAenabmeodlgWhxm6aWleer� <br />_. _... _ -.. <br />]i�_J— _ ._—....._ ...—._ 4 <br />Manifest # <br />Emergency <br />Response <br />Phone <br />(make certain <br />one is listed) <br />Disposal <br />Facility <br />&EPAID <br />(make certain <br />one is listed) <br />Make <br />certain EPA <br />or State <br />Waste <br />Codes are <br />listed <br />Store <br />Representative <br />Name & <br />Signature <br />(to be signed <br />once manifest <br />is reviewed <br />and information <br />confirmed) <br />1 e­Fpa uu <mee rub rtny Mamtl em <br />Disposal Facility Name & <br />Signature (included on final copy Questions? Call the StrongPak Hotline800-815-3770 <br />received approximately 30 days <br />after service) EPreguntas? Llame 800-815-3770 <br />©2014Stericycle,Inc.Allrightsreserved. COP Sdericycle <br />6 Ver. STPLS-10-2012 EXpertSUSTAINABILITY <br />StrongPak <br />