Laserfiche WebLink
M r r =) D -0 CC) <br /> 0 0 O 7 = -1t:, O <br /> Tn o Oon, <br /> � � - _j <br /> W � � = Q' ON � <br /> O0 0 co � Er`° wON <br /> Co c4 06 it <br /> rl <br /> O -n r—-n --j y o <br /> m arrype IFann designed for use ors elite(12-pilch)typewriter.) Fym Apo-o.er; Gd11B Nc =S�:�A] m m C) j � <br /> M �rFn S.Generator Ip Number 2.Page 1 0l 3 Emergency Reapaose Phone 6,Mar~Tracking Number O <br /> _ "uNIF M RAZARDO115 011410898 F L E , , <br /> WASTE MANIFEST - <br /> c r;enerator's Name and Halling Address Generato>'s rte dares I different than maihco <br /> O <br /> Ong address, \ <br /> N <br /> W 3 r9 <br /> Generator's Phone. ^^ a- m <br /> f. ranspertarl ampany ame US EPA ID NumW Q <br /> 7 Transporter 2 Company Name us EPA III Number r W W O— <br /> n <br /> O � O 7 <br /> 6 Designated Facility Name and Site Address U 5.EPA IO Numb. �--��--� �- <br /> CD <br /> CD O <br /> 0 <br /> Facilays Phone. <br /> ga 9b.US.DOT Dasaiption(including Proper Shipping Name,Huard Class,IC Number, 10 Containers r t Total 2 Una ,3 D j <br /> HM and Packing Group{daaYYl No Type Quantity WI"da ,E-' z <br /> D <br /> o Q CD o <br /> O v Cn <br /> z 2 n <br /> N <br /> C0? — O <br /> N C)- <br /> 0 O <br /> CD lD <br /> .. O <br /> O <br /> v <br /> 16.Special Handling Ins"Chons and Additional InPonnalmn <br /> 7 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this wirsignmenl are luny and accuralely described above by the proper shipping nal and arm dins V pedax^ <br /> markedand labaledlplaCarded,and are in all respells in pmpereondibon For VanspoR according to appbCable intemaupnal and national gavemmental regulators.aeapprt s^inr^r'e�='=-'"c`4•�y <br /> .-f <br /> Expader,I cemly Thal the contents of this consignment conform to the terms of the aMaChetl EPA Acknewletlgmenl of CMsenl. Q <br /> I ceRay that the waste minimilafion statement identified in 40 CFR 26227la)(if!am a large puani generatarl ov(b)if I am a small quantity generatorl Is true. <br /> nerato sl flervi Flnnted7yDed Name Signature -• �a. -�' <br /> _jI 16 Intemabonal Shipments <br /> 1.- 11 Import to U.S. El Export from U.S. Part of enoy'axit <br /> Z Tnansporher signature fm exports cnl Date leaving U.S. <br /> IX Lu <br /> 17 Transporter Acknbaledgmenl of Reolil l of Materials CD <br /> I-- Transporter t PrintedlTyped Nameignature CD <br /> O � <br /> 6 r-f <br /> Zq Transporter 2 PrintedlTyped Name Signature O <br /> a n <br /> O <br /> 18 Olscrepency -6 <br /> 15a Drscrepawy Indication Space yuan .r <br /> ❑Quantity ❑Typo ❑Resioue �. .r fn <br /> Manifest Relerc„Ce Number <br /> 18b Alkmate Facl!�r�Generelorf li 5 f 1-,tl'Ysn+tier 3 <br /> J CD <br /> a <br /> LL Faci[Liy4Phil O <br /> yQj 16c Signature r:t r,.,.r”,,�.Faubly(pr Gerreratwl <br /> � � G <br /> 15.Hararditi 1"+, ,run Management Method Codes(ta.,codes lorhuardoua waste eealmenl,d,spocal,and recycling syslemsi <br /> WO 1. 2. 3. 1 (Q <br /> 20.Desynaterl F C -ner or Operator,Certification el receipt M hazardous materials cauerad by the mandeat socapl as noted in Item 18i 7 CD <br /> I Pdntsdfryped Na raflum CD 0 <br /> +I C 0 a <br /> EPAFnrm 8700-22(Rax 3-05)Previoust huts are pbsolete, JtNERATCIR 51kl COPY <br /> � C <br /> CSD T <br /> W O O <br /> O_ fn U1 <br /> W 00 <br /> W <br /> v CD W <br /> CD v <br />