Laserfiche WebLink
or twe. (Fonts desionW for use on elite (12 -Ditch) A.) <br />Foan ARptave ,,0MB No. 205G -W39 <br />4iFORM H DOUS 1. 10 Number <br />2. Pae 1 of <br />3. Emo Response Phone <br />4. st <br />�,+. c,}i i _. ;fi) <br />�— 4907- <br />ess " enerator's Site Ad&ess {K.different than tata " ) <br />6 Generator's Name and Mallin$ AddryG <br />ftt1lo VU$}'! <br />IuW,&1�10 CIA- <br />p.i i f CA X62.4a3 <br />GeneratofsPhone: <br />6. Transporter 1 Company Name U.& <br />+'.ak. ti'LE� ts�,!l�wT $_l�kL,fftit�t <br />7. Transporter 2 Company Name U.& EPAIDaWNnber - <br />8 Designated Facility Name and Site Address U.S. i u <br />RF!W.KJRLE RECOVERY <br />c. AI.J PILO BINU. <br />FaciAty's Phone: Ow meq.,,. 7 .p 'ap <br />93. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, tD Number, <br />10. Contalnem : , r.�6'A otaF x•` <br />12. Unrt: <br />; 13. Waste Codes <br />tiM <br />and Packing Group (if any)) <br />No. Type Quantity <br />Wtivol. <br />7 <br />1:;:,n. r:r+,r�-+ s as •r <br />rt <br />_.. <br />Z <br />2. .tt•+t RMIA <br />TZ�1 i t! .SJ�(^gy �•a;.. rt i Z t,70 73. <br />.. ... _.. <br />;..t'r'COL) (CALIMNZA Rit.ixULA "' u .Oi4LY ) <br />on fj r <br />' <br />4. L _.3A 1 7, <br />14 Special Handq Instrirdions andIWormatiortr <br />the T—."2! 2{ AP# V,b <br />;i' {y sr'E1ia td.t6 ( P1%CAG' t, 7,i f /4]••Cy�i tr <br />15. GENERA►t7R SlDFFEROR'8 C TION: thereby declare that the contents of this consignment are fully and acaxaaely descr above by the pmper.shippm9 panne, and are daWfled, padsa* <br />marked and tabeledlplacarded, and are in alrespects in proper condition for transport according to applicable international and national H export shipment and I am the Primary <br />�^ <br />Exporter, I cm* that the contents of.dnis t conform to the teras of the attached EPAAckngwad n*6f'of Conssit � r � f <br />I certify that the Waste minimization t idended in 40 CFR 262.27(a) (d I am a large quV* generator) or:(b) (rf I am eemad quantity generator) Wp ! <br />GeAerato+'slO 9Ws Printsdrfypsd Nama t S` lural' s' '' ✓ ' ,-� tdorttllf„D& Year a <br />.� <br />f— <br />f6.IntemationalShipments <br />❑ Import to U.S. ❑ Export from U 3'" Port of eniryleA <br />Transporter signature (for exports only): Date leaving U.S.: j. <br />IX <br />17, Transporter Acimowledgment of Receipt of Material r <br />Tfan9pert8rTPr;rAWyp&"smeSigrnats+re Month Day <br />/ <br />fYeari <br />ca <br />Q <br />Transporter 2 PdutedlGyped Name . S' Month Day Year <br />18. Discrepancy <br />18a. Discrepancy Indication Spare ❑ Quantity' ❑ Type ❑ Residue _❑Partlal Relechon.. ❑ Full Retdi <br />s ... <br />Manifest Reference Number. <br />I Sb. Alternate Facility (or Generate U.S. EPA ID Number <br />U <br />LL <br />Facility's Phone: <br />W <br />t 6c. Signature of Altemate-Facility (or Generator) <br />Month Day Year <br />22 <br />19. Hazardous Waste Report Maragement Method Codes (i.e., codes for hazardous waste treatment, disposal, and recyciing.systems} <br />LU <br />t� <br />1 2 3.. <br />4: <br />20. Designated Facility Owner orOperator. of receipt of hazardous materials covered by The manifest except as noted in Itsm4a ' " <br />PrintedlTyped Name Signature - Month Day Year <br />