Laserfiche WebLink
Please print or 9,(Form deslgnad for use on efite('i2 pfkah). ewritsr.) atm APpt.4ved.OMB No.2O5Oa39 . <br /> • t;Ganeret�t]Number - <br /> 12.Pad Cf �:' "ntyj R s se pis» 4:pMa�nkt'el;t Trecking)!iunti6er a�[ <br /> I�FfIFORtd NA?E1R�10, $` bw'7824€3 LIS i.- {�_ �s ��tfa�J: D -14507 <br /> �?R <br /> j WASTENIANIEE5T <br /> 5 V;enerahoda Name artrf'Maipng Addrtsa Nrj6ratoes Silo Address Of Marent than mailing add(ess} <br /> G TS ill + $trop 10- Led,. ihop 1L�- r,.Od . <br /> Stmc'�S. Gyt Cry <br /> Gerfslatarsl5hana 'xa T! �4ra9.i f tT.di ZA 95240 -31PFJ <br /> '�-TNWVM-MSYSTEMS, INC. <br /> U.S;EP tO Number TXR600091205 <br /> 7,TransporterMr panyName U.S,.EFRiDfEurnher." <br /> &'poslgaaKl AcififyNameandSiteAddram SAFETY-KLE�,14 SYSTEMS, 'M2, U.S.EPAIDNurnber <br /> 6000 88TH :TMET <br /> '90AMENTO tom- 055132 <br /> Facifly's Phone: <br /> gh.U.S.QOT Osk4tbn Rmk dkrg Proper shipping Name,HazaW Class,ID Number, 10.Containers. 11.Tofai 12 liiul. i3.Waste Caries <br /> ' <br /> and Pocbtng Group(1111 am')) Nb. Type. t3uantiiy 4YtNol: <br /> 1 fi F3G FAGS cA €AZAMOUS WASTE, LIOF 0 i-34- <br /> (AGI <br /> 34'(AGI 3US BRAKE MEANER) <br /> z .'.. 2. MO" RCRA HAZARDOUS UASTE, LIOUIR <br /> {s >ilk l �# €1R .:�49HER SOLUT IW � } <br /> 11 <br /> 4. <br /> 14.Spall HandWtg fnstru-Ans and Additional information 7 Elf)5Ct) �iE 8 9 ` y�',.�jvoV3. 0 VI ' -SG: <br /> 4"'FkR �'i`!'�.�iCir_�11,Y 41-R-0R--4e- --9,60� J$9 <br /> " TSI} <br /> fN. I " <br /> 15. (iENEgATOR'SIO.EFEROR'S CERTIFICATION: I hsreby declare that the contents of IIII& nstgnmentare my and Msately described above by the Pioper.shlpping nant,all are dassiGed,pe&t gedj- <br /> merge¢and Isbelsd p]acaided,and are in ail respects e;proper condikn foctmasporl acxorditsg)O applicable irikamaffgnaland national govemrirental mglmbcns:If exportah0riefd and I Ern the Primary <br /> Exporter,;I'�erttGatlha.cairtentsofthis Donsgementcpnfm,mthelarmsoftheattached.EPAAdmowedgmentofConsent, <br /> "• I certify that the waste mEtiimlzatlan atateman_1 iden6Fedln 4D CFR 2$2,27{a)fit!am a large quenllty ganelatar)or(b](if a small.gpentity generet�t):'s true. <br /> Ge t ffpmz s Pfin yped Name. Signature +^ Month Day Year <br /> mAe <br /> 16.intemationalrShiprrrCrsts ` ' <br /> Impm to U.S F rortireln'lf$.."„ i Rrktof.entryfexjl: <br /> Transpoter signaltlre(forexpdris only): - pais leaving U.S.: <br /> 17 T'snsporWAdmowledgment of Rece!pl of Ma6erials <br /> ,Fy T or 1. Name Signaa ra '. Month Day <br /> Rilii 7l y <br /> zTran otar 2 Printed yped Name 5igneiure i, Mon h Oa Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ ami ❑Type ❑Reafdue ❑Partial Aeiertlan ❑Full Rejaction <br /> Manlfast Reference Number. <br /> 184.Alt�nale�ecill or Generator .U.S.EPAgllJurnbra ' <br /> LL "Pmomeril' sPhone, <br /> f 8c:Signature ofAlterpate Fad ltty(or.-secretor] Day Year- <br /> , '.i a.Haiardous WssteRaport Management Melhgd Codes(.e.,codes far-hazardous WsstY liealnMta dlspvset,and recydN systems) <br /> F11 2' tt14 i <br /> 20,Designated Fa*y Owner of Operator:C 'clkn of m osipl of hazardous materiels covered by rise manifest except as noted In Stem tea <br /> signature Mor11h Day Year <br /> Printedi ype la <br /> sy f f1111101 i <br /> EPAPOIM8700-22(Revl-O5� Prevouseditions are obsolete. � SIGNAIE13 FACIUTY O GENERATOR <br /> µ 11474:E:'I:a6023 <br />