Laserfiche WebLink
M cA -uop <br /> v = V O <br /> N <br /> 7 -0 v <br /> v M O N G1 <br /> TI <. O) N <br /> O _ 7 <br /> M CD <br /> M. C v <br /> O yCAL000373076MG TYPE=GEN_EPA_ID&id=39 1 1JOE <br /> () <br /> rel <br /> M <br /> IIIllllllllllllllllJlfll`IIIfIfJJII IIJJ��++II IIII I�I�uuII ryry NJJN���� M rs <br /> I )�, Please pi7hl or type. 1111�II�IIuI�N1iEII� N <br /> ' Form (� <br /> UNIFORM HAZARDOUS I-Gerbnnrw m Number 7 Paye 7 of 3-Emeryency Rospomn Pl`— 4 Mem7st Fine Nar�r SIB Nb 2050.0p„a <br /> WASTE MANlFESi L'kRQ1P1"- 775772GEr" O 249 <br /> 9 FLE O <br /> S.GeneralorS Name anyMeainq Add,eas `F C) <br /> } 11f Q O 1 I— Generator's Sea address(It d0ler T1 fia,mw.Nm addre.1 <br /> �' �� "rOSrfH0l�5ftcfA 310 id Df. piHR7iN�t_UItIEF t <br /> ar Eienpva!a <br /> Ganerapr's Phnrs:: ^Ti.l'4:TTJNt CA `I .t... <br /> "^ U DR MHR7(' 3 <br /> 6.TmnepMer I Coni Name <br /> 7.Tran6porler Z Company Name <br /> k50@p� <br /> tJ.S.EPA IN q-•,-. C <br /> �a B.Designarad Faclity Name and Sire AdNess ' <br /> [DEF•r <br /> r <br /> !` FacilHy'e PhOn ° <br /> 9a. 91,US DDT Degcnph,"Iindudirg Proper Shipping Name.Hazard Class.fO Number, <br /> �k HM aM Packing Gm p f! yl t0.Conle!ners 0 <br /> r` m - Type <br /> o <br /> � n <br /> z D <br /> W <br /> 7 <br /> 3 — <br /> Ir,� 14.Speelal Handling lnsWcliDns and Addiryenal tnfarmas'on <br /> 1,1705id <br /> 110524(No n'RC: igl3id Waste (i'A x9mori.-,RCRA SolL4osepackf (CA Qn1Y> - LD senarL,, <br /> - .. -. . --'awe. �a,�IsjSyy,�+,uaYntbei+wxt,w,araM,t�: ►a�41Car�yyv,l�:�:rar4*1'the t�.�rK.�,..� <br /> 1 15. GENdandra,4pdFpEROR'S CEgiIFICATION:Iherehy declare that the cOnrenls of this mnsignmenl are tally and accurately described above by[he proper shi <br /> marked and faheladlplawNed,and are in all ra c <br /> Exporter.l certify Mat the conle"Is of thisoonsignme ticp��rto ndiliontor trar5pnrl acrArding to applicable imemalional and natlonalgovemmental ropssn"pingname,arrf <br /> f w"that the waste minimi78aon slalemam idenfient in f CFR N l27(a)(d s of the <br /> attached a Euan cknowled9mem at Consent. <br /> reg expos sh,omenl and l em ft pnnay, <br /> Ge IqS! mYs Pnni-Vyped Name 4 N enerator orb iflam a small <br /> g ) f 1( uantity generatorh is e, <br /> � 16,In1ematicnal5hipments � � �- i �- Mor'n Oar <br /> ~ ❑Impart to U,S, l•J x <br /> 2 Transporter Signature(fdre ^' <br /> exports only}: Export from Pondfenfrylexilr <br /> Lu 77 TranspoMrggrmmedgr19,1 scei of Matenals <br /> l Tmnspprler i PrinledlTypsd Name Date leaving <br /> O y Signallua':I7 T.D.I;'lr i" Fi11Ban�a ..� ' <br /> Year <br /> iransporter2phnW� --'� Month Dal <br /> i) YPed Name <br /> 18.Discrepancy + ((•�DaY vea <br /> 16a,Discmparky Indication Space �s - <br /> Quantity T,❑TYPe ❑Resitlue <br /> ❑Partial RGI <br /> F 18b.Allemale Fa0,ty(or Generators ❑Fup Raleioes,, <br /> � Manilest Reference Nwnber. <br /> U <br /> LL Facility's Phone_ U 5 EPA ID Niemb,•• <br /> O 18c SlgnaNre ofAllemale Facility(Of Generator) <br /> N <br /> 4 <br /> z <br /> 19.Hazardous Wasta Report Marta More, <br /> w L>av year <br /> 1 gement Melhdd Codes fi.e„epde5 for hazardous waste IreaMenl,disposal,and rec <br /> j } <br /> i � I 2. Ycling systams) <br /> 1 3-T 11 . <br /> 20.DesignaledFaciiity Owner or 0 ' I a (� <br /> Pnnted/fypad N peralor CeNhca"on o1 receipt cf hazardous rnaletlals covered by the manifest eMcepl a3 n iq Item 16a C O <br /> "11 a ` n <br /> 1 Signature D O <br /> ( E kk Q <br /> EPA fo m 8IIX.22Rev 12.17 <br /> � I Previousedilionsareobsoiele. <br /> DESI NATED FACILITY TO GENERATOR N <br /> CD <br /> CD _ _ _ _.. v w <br /> o cn v <br /> N <br /> m crl <br /> rs <br />