Laserfiche WebLink
cn <br /> FOR SERVICE CALL: fir=o O \ � <br /> O rrrwnr.,nrr,..r rr crc Vfll DBA FOPIMNG WUESao2�6 lEltel O N NN <br /> Z - v N <br /> Fo m ApgroYetl.OM915o.'L050-0O39 f C O <br /> D <br /> :OR Sr <br /> Please print or type.(Form designed for use on able(I 2-01Ih)NPe1"'rit®r.l a-Mamle�r n.caln >tumn.r �_ O <br /> )(XON Gene min,IV NiirnMr 2 Page 101 3 Emerc encY Reapon ePhtlne 9 ��� <br /> D 8G0 UNIFORM HAZARDOUS ~' CD <br /> Z <br /> WASTE MANWESTGeneiainrs Sire Address frt dirteram man mailing atlareasl E3 <br /> -ORf - sePner„I.•a N,�i..,ne M,o�r. ,n,e:., -- <br /> m 62-6 v D <br /> lzl p- <br /> V J Genealw s"hrne. US.EPA ID Num48r N <br /> 67—cpej'T f C'—,-nn,N1— CD <br /> JBteLIS.EPR VD NVmper Q <br /> ]TrarrspPrre: O <br /> :US <br /> I S.Oesyneletl Fa:�Ln:Norrie an"i Sale 4dtlre5c U.S.EPA IU Number O G <br /> T) I <br /> It <br /> r F-II Phone N <br /> yy 91,-U.S.POTpescnpnon iincluding Proper Shipping Name,Hazard Class.lo Number, to.Containers tt-Tata' 12.Unit t3.Waste Codes <br /> HM and PaCkiag Group llranyll No. Type Quantity W1fVn1- 3 <br /> qO (D <br /> K V) <br /> r-h <br /> LU <br /> LU z O <br /> I-� <br /> F-t <br /> 3. v <br /> O <br /> N <br /> O <br /> a � <br /> O <br /> iS <br /> 54 Special Na^dl,rg hsrm�.on—d,Idl, al lnbrmal,on (D <br /> G <br /> (D <br /> 75 GENERATOR'SOFFEROR'5 CERTfFICATION:1 hereby declare that the contents of Oils r nsignment are fully and accurately described above by the propershipping name,and are dassdied,parksgsd, <br /> marked aril labeledfplacarded,and are in all respects is pmper condition for transport a=rding to applicahle,intamadonal antl national govemmenW regulatiens.It 91 shipment and 4 am Site Psmary r-F <br /> E*orter.I oe,nty mal me cw'lents of this consignment Wnlmm b me terns of the attached EPAAcknowledgment of Consent. <br /> 1 opAfy got rhe waste minimization statement identified in 40 CFR 262,27(a)(if i am a large quantity generator)or(b)(d I am a small quantity generator)is true. O <br /> Gerrerdroe.s/DAerors Frfnred77yped Name Signature Month Day Yea[ rt <br /> sy <br /> CL <br /> .1 76.Internacional Shipments (D <br /> � ❑Import to U.S. Export from U.S. Pori of enVyleut. <br /> = Transpwrer signature(for exports oniy) Date leaving U.S.. " <br /> W 17.TransponerAcknowledgmeril RacaiptafMalanafs O <br /> Transporter 1 Pnnted/Typed Name Signature Month Day Year ID <br /> a CL <br /> CTransporter 2PrintedrTypedName Signature Month tray Year O <br /> H -0 <br /> 18.Discrepancy <br /> 118a.Discrepancy Indication Space ❑partial Rejection <br /> ❑Full Rejection <br /> ❑ Cluartity ❑Type ❑Residue <br /> Manitesl Reference Number, <br /> 18b Alternate Facility(or Generator} U.S.EPA ID Number <br /> J <br /> U <br /> L FaCilitlls Phone' <br /> I&Signature of Ademate Facility for Generator} Month Day Year <br /> a <br /> z <br /> y15.Hazarde us Waste Report Management Method Codes Ii,e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. 3, 4. <br /> O O <br /> n <br /> A Deaignaled Fac4lty 0errwr or(jpbralor Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a O <br /> Prmtedltyped Name5igna3ure Month Day Y1W C)- <br /> EPA Form 8700.22(Rev.3.05)Previous editions are obsolete. <br /> O <br /> CTI <br /> !y W <br /> (C2 O <br /> O N <br /> O <br /> O <br /> W <br /> O <br />