Laserfiche WebLink
LADING/MANIFEST' '. <br /> 1. <br /> S'htpPePs US EPIC ID No (If APPlicable) Doccu�ment{No. 2.Page 1 <br /> LL OF <br /> hiPPersNameand Mailing Address t � R " <br /> d i <br /> ya <br /> o of Narrfe 6PA ID Number A.Transporters Phone <br /> 5 Ctanpor#eY 9 C y <br /> Ftart por ars Nat7te k $2 f 1D NumberB. ns o Tra p rters Phone <br /> 7�11: 1,5 0 0 <br /> 'rl��a# ff *f4d Itret 1q. US:EPA ID Number C.Facility's Phone <br /> on ars <br /> k1 iP ��5� 12.C fain 13. 1ni <br /> t w Quantwol <br /> Na. Typo Quantity w <br /> " IT <br /> 12-5 <br /> i <br /> 3' <br /> " - - - <br /> 15.Special Handling Instruction and AdditionW`infortr<atiGrt � <br /> a* <br /> L. <br /> f� <br /> ' 4.. %¢Cy# t 'gyp'& g £ <br /> ¢ S' }?'A4 §" �Yz@'^'Y §� <br /> Aa-` �4` " "°tet° � ri A.4<..,-., r,IPT <br /> 16a.US CLOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION: is to ae by met he aoove-named mataNa�s are p openy uesslree,de3c i Pgckayd m® anti�sbeleH ahtl e a <br /> a ape <br /> condition for Vans oration acmrdioto the a hnabis re ulatlgns o3.Vre "t�f'f ns wfailaY� <br /> PrintedlTyped Name Mdh Day: Year ' <br /> aLe mc� ■s ` <br /> glib.NQ.N•REC+ULA7ED SHIPPER'$GERTIFICaATtQtJ, 1 certify the materials describo plyove on this,form are no tact t, federal requlafr4ns for Tr 000 ar ar tai l <br /> •' PfintedfrypedName cffh PaY' Sear <br /> fi <br /> 47,TrAnspoetef 1 Aekhowledgementof Receipt of Materials <br /> fit Pnrt4ed/d)+ped Narne Sighatur� Month bay Year. <br /> S� 18 TfailsPorer.2 Ackna uledgemefrtgf fieceiPi of NtatCrials <br /> F ted d Na e Sigma M� pay Year <br /> E <br /> K <br /> 19. iscreparicy Cniiicatiot Space <br /> F <br /> .fit <br /> C . <br /> t 20,Facility dwner or Operator:CoAftation of receipt of materials covered by this form except as noted in Item 19. <br /> _.I <br /> t 5' <br /> Printed/Typed Name Signature Month Day Year <br /> EMERGENCY 800-468-1760 <br /> _. <br /> ORIGFNAL�RETURI�d fiO GENERA"©Fi Foff,n NO oz sozs1(03Mo1,5) <br />