Laserfiche WebLink
006100090SKS <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2. 1 of 3.Emergency Response Phone �4.111J!a ntfestTmeking Number �/WASTE MANIFEST d©6DZ r�af`8 10006100090 SKS <br /> 5,Genpr7ator'y Name and Mailing Address s iN' Generator's Site Address(if different than mailing address) <br /> c=pA�� o6334Q7 <br /> Generators Phvne: <br /> 6.Tmns Mer 1 Company Name U.S.EPA ID Number <br /> FenC� - �C. rX 04118 <br /> 7.Tmngpoder 2 CompJa��VNa�m/e� U.S.EPA ID Number <br /> Ckl� is lr�i 1A��' �l��f""`�Q�1 l►E7.. .,c�r'�i M/t�.p D3 ZJ ZZ2a r+ <br /> 8.Designated Facility Name and Site Address yr, ew, Hhe AV�, S&N y>s U.S.EPA 1D Number <br /> 1 ��pp f� ir-•i'P'#may y �J rJ <br /> Facility's Phone. a0 ["v-�c� �Us� � 6�` f3 <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> No. Type Quantity Wt./Vol.HM and Packing Group(if any)) 13.Waste Codes <br /> /�� <br /> n%0 W e 2/) z p{Vl BOO 2�L <br /> q C5iL Ftt--MW <br /> Z 2. <br /> m <br /> t7 ' <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TGD• 'ST •�? <br /> 2Al- NIER_6e�ir✓ oa 10-G M sI <br /> TF1- �0-tc+r�T ��7'�in►e� �/ <br /> G�N� R+t g Y u ot&/, Y 1 �1' �gk HLT&Mb Dom✓ s fZ <br /> ��` 1 <br /> 45. GENERATOR'SfOFFEROR'S CERTIFICATID01:Thereby declare that the contents of this consignment are sully and accurately described above by the props ipping name,and are Gassi ,package <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. port shipment and 1 am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAGmowledgment of Consent. <br /> 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)(T I am a large quantity generator)or(b)(if i am!aall quantity generator) <br /> Generator slOff orsPrint !Type a Signature Month Day Year <br /> fP <br /> =-I M.Internatil5nal Shipments <br /> t— ❑Import to U.S. ❑Export from U.S. Port of a !exit: <br /> = Ttansportr signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> OTran er1 PrinAt�yped Si a Mo Day Year <br /> a L.e too <br /> C Tm drT spoder2 PrinteSignature Day Year <br /> Y-rSt —' Q 1� <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: - <br /> w 18c.Signature of Ammat Facility(or Generator) Mor4h Day Year <br /> Q <br /> y19.Hazardous Wase Report Management Method Codes(i.e.,codes for hazardous wast treabnent,disposal,and recycling systems) - <br /> p 1. 2. 3. 4. _. <br /> 20.Designated Facily 0 eror Operator:Certification ofreceipigPiezardous materials Dogred by the manifest excepts in <br /> Printed/Ty Name SgnaNre Momir Day Yea <br /> Jim <br /> EPA Form 8700-22(Rev.3-05) Previous edi onsareo solete. <br /> 0741Z00-3/C5-�-7-77 AIMSIGNATED FACT YTO 5PTINATION STA (IF REQUIRED) <br />