Laserfiche WebLink
Genmatar ackrNtarltedges that RO matedS � has occurred ether in the characttillMs or it the process general rI <br />Please print or type. f�the Oft 01018 <br />No2050-00 <br />39 <br />UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone It u <br />WASTE MANIFEST C A L 0 0 0 4 2 0 0 23 ( 483-3718 1 8 3 F L E <br />5. Gers?rafir's Name awr u.iii— A,,,,—. _ <br />i4SW W Hi iU . . - SAME <br />L41ldi O!1 � <br />enerat . Plwne: <br />Transporter 1 CiSnpany,N&M <br />Chian H m A*ownenwsorwar 1 , <br />Transporter 2 Company Namp <br />C1eaM11'1aFbws EnYbmIllieirltilliI Sgr4loes_ I nm <br />2247 Std IiWhww 71 <br />9a. 9b. U.S. DOT Description (including Proper Shgjrtg !Name, Hazard Class, ID Number, <br />HM and Packing Group (•f any)) <br />1. <br />UNIM WA.t9TE FLAMMABLE SOLIDS. ORi"IC. N.0_S_. <br />X OMORBp1'1` BOOMO N TANNATED W1T1HGAS ANDOILI.4.i. <br />3. EPA ID Number <br />l:EO881723513" <br />10. ContainersIType Quantity I Wt.Nol, I 13. Waste Codes <br />Caatlact letatrred DY <br />marked and labeled/placarded, and are In an - - - � �. — -- - -' .- r.,,.-. a, <br />marker, l certify ed/ the riled, an of this erects In proper condition for t usport acakding te applicable krertmatianerand national gowemn�rtal raguhtkxra. <br />contentscor*nmerd conform to the arms of the attached EPA AcluxWedgmerd of Conserd. <br />I oert fy that the waste minimization statement identified In 40 CFR 282.27(®) (If I am a large quantity generator) or (b) (Ifl am a smsN quantity generator) Is true. <br />J s SlgnatVj"-�nShe <br />18. International Shipments❑ Import to U.S. ❑ Export from U.S. Port of entry/exit <br />Transpkeralgnsture (for exports only): Date having U.S.: <br />IN 17. TransporWAckrKWo mentof Recelpt of Materials <br />18. Discrepancy <br />18a. Discrepancy indication Space <br />18b. Altamate Facility (or Generate <br />J <br />V <br />FaciliVs Phone: <br />W 18c. Signature of Alhmate Facility <br />CD <br />19. Hazardous Waste Report Mana <br />+ H040 <br />20. designated Facility Owner or OI <br />Prirr[�ITyped Name <br />TA <br />❑ Quantity ❑ Type <br />anent Method Codes (W., codes for hazardous waste treahnent, disposal, and <br />2. 3: <br />calor: Certification of receipt of hazardous materials cowered by the manifest a; <br />❑ Residue <br />systems) <br />d in Item 18a <br />❑ Partial Rejection <br />U.S. <br />I amthe Primary <br />❑ Full Rejection <br />EPA Form 8700-22 (Kw, 111-f) PnavTOUS editions are obsolete. _ HaDE <br />GSIGN TED FACILITY TO EPA's e -MANIFEST SYSTEM <br />fe;lrr Rtors has the appropriate retells tilt and VAaccept the waste the generator is sh"Vwj. Wqr 2"1 q%2511Qt PPW ` <br />i <br />