COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Please print a Formdesi designed 12• itch typewriter.) Form Approved. OMB No. 2050-0039 P b'P ( 9 ( P ) YP 1 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. J C NATEU FA(;ILI I T IU Utti I INAI IUN b IAI t (If KC,, UlKtU) - .>r c f - w, rp, - 7 �(8 r r �'vx �;�'t7# i- v _ - .. UNIFORM HAZARDOUS 1. Generator ID Number fl-: 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number '- FLE WASTE MANIFEST r#i._ti:vsv,._T-r n^, c -E 008680278 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) L}0 e1 -t✓ r -al # G ## 1.I:t3 Fl .'i4`'t,=P` 41a -9i-I . F. W TEF D Fi 4 'Ir ii -r.7 E, Generators Phone: a _ _ -- -T 3Sd. :-1 a- �1 _ r't'-' 6 Transporter1 Company Name U.S. EPA ID Number e .I >_ _'l. E" �rj:: i"'3 A3.. ry.- i -.F � 5i. Y4__- jii i' f'•h� 4ip?itj.1 1, =_? ' 7. Transporter 2 omp ante U.S. EPA ID 7 :V ,Nuumber t/ J 8. esigna ed Facility Name an ite q/3dres' 2 i i t Ce r, { u r y E M IN L C U S. EPA ID Number Fe ,n j e = N 89406 - Facility's Phone: ry 7 a I fq ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11. Total 12. Unit 13, Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. 1tr i1 1 lja:t, H r s -it? SolutioTts 8i P —� l llf - r'•Lt Fo Iii. FR15##154 ..- W Y.AL}N1993, '�} ~} � Flammable 11£lr_ll�cy !'t. 4� s. �. ' !' It+1 L�?�. <11 i?0O1 A l ,`�' a )moi ; A - P L'7 1 i. �:• C. FR;: #i _ 7 UNV350, Waste Aer-osols, fla-mariable 2. 1, ERG#126 1 1 F 00020 331 D001 4. 14. Special Handling Instructions and Additional Information 1 i 05 ? _, , A- 1 e a ct, ) i u i w 2., 1t 05 18 '. i am ma h 1 e i tu i d- w , q -,i ...oci--- Fr.aac ,,14115iq Aero -c., F 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and and are In an reapacls' proper condition for baraWrt according to %%table Inlemational and national governmental regulations. If export shipment and I am the Primary Exporter, I cernthal the Contents of this oonsign1 conform to the terms of the attached EPAAcfrnowledgment of Consent. I certify that wasps minimization sfaternerd_ In 40 CFR 26Z27(a) (d I am a large quantity generator) or (b) (If I am a small quantity gene ) is tru . arm a month Uay Year F nternationa hipments 1 ❑ Import to U.S. ❑ Export from U.S. Port ojrentrylexit: z '— Transporter signature (for exports only). Dat� ving U.,4:: J LU 17. Transporter Acknowledgment of Receipt of Materials ransporter 1 Printed[Typed Name a ra Month ay Year eL lA!'tf: h an y � i ex Transporter 2 /i� / Ignature Month Day Year IX I I// V7 117 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number V L I Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year z I I N19. Hazardous Waste Report Management Method Codes (i.e., cod{es for hazardous waste treatment, disposal, and recycling systems) 20 Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba rintedlfyped Name Signature Month Day Year hC,1 IL n n rV I EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. J C NATEU FA(;ILI I T IU Utti I INAI IUN b IAI t (If KC,, UlKtU) - .>r c f - w, rp, - 7 �(8 r r �'vx �;�'t7# i- v _ - ..