Laserfiche WebLink
r'n t�2 <br /> « 4/ p . 0.0039 <br /> Ple«se`"riot or typo.(Poon desipnetl for use on citta(12 pitch}lypevinfer.} _,7U IF ftM HAZARDOUS I.Generator ID Number e 1of 3.Emergency esponso Phone 4.ManiFest Trackin Numberoved OMBNo.205AN tilKS <br /> WASTE MANIFEST t..r'i5.¢' .i..,�t..s1' ., t,yt1....,.s L. � • 006n, 57902 <br /> 5.Generator Name and MailingRddress Generator's Site Address(iCditferentihan mailirrgaddress) <br /> 1'17yC't; A7` `"rt!SK1? <br /> I <br /> A zR"7th ST' <br /> Genera�oi§Phone. r r &PV <br /> 6.Transporter t compan` `ame U.S.E I u <br /> ani,•E i'Y K(.M_N ay a rS IS IN u:s:EPA ID Number <br /> 7.Transporter 2 Company.Name <br /> }( } ?!':it �!'tJ f1Ci+ .CT�Ii is Uf: fit.t: ttnlElihi _. f . <br /> 8.Designated Facility Name and Site Address U.S.EPA IQ Number <br /> f t„, AN HWWOR'3 SAN )IX'E' <br /> Facility's Phone: A 0I'll 4 1—0C3`6F <br /> 10..Gontainers i1.Total 12,Unit <br /> ga, t3b.U.S.DOT Description(including Proper Shipp g Name,Hazard Class,ID Number,:,. 13.Waste Codes <br /> HM and Packing Group((Cany)) No. Type Quantity WtNol, <br /> ia!;f i <br /> _ 1 Rf'RA HAZYA0q`tJtlkiti? <br /> t' c' t.._7 7?130.4 U; rI r of t.7t,rAiriir,f1' i g {"T't, R" T`t~ 1 �M <br /> W <br /> 14.SpecialHandling 1Istructions andAddilionat informati n <br /> rU75) <br /> r,2 <br /> :�r f1f F)+F.K CY #1 'n arc#-170,0t6`9 TFI / <br /> 15 f- ENE OR 1 PER 'S` A :tf eP b d ro Ed ils4rf a nni to 1 and fat s 'b • v' pGpjied i ping name;andira dassiBad.Pad ag$d, <br /> ental regulations.If export shipment and i am the Primary <br /> marked and labeled/placarded.,andare.in all respec s in proper condiilon for trenspoft according to.applicable international and national governm <br /> Exporter,i certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> jo,rGfy that the waste minimization statement identl led in 40 CFR 262.27(a)(ift am a large quantitygenerator)p(11)(111 am.a 61661quanfity,general fIs true, Month Day Year <br /> ane[ esi0ftetg?s Printed/Typed N.a 5' Signal <br /> u 16,Internahona Sh DmentsImport to,U:S. Q Export from U.S, Porl oDenlrylaxih <br /> E— Date leaving U.S::. <br /> ? Transporter signature(forexpc s only}: <br /> 17.TransponarAckno+Wedgmenl of Receipt of Matariais <br /> 7ranspor)a r ntedlTyped Name <br /> Signa—V Month Day Year <br /> O CYr <br /> ''� f Si ature - Month Day ! Yea <br /> z¢ Transport [ ori• e NaTn <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space L I Quarlity Elm ❑Residue ❑Pettit Rejection ❑Full Rejection <br /> Manilast Reference Numbec <br /> UIS,EPA ID Number <br /> i8h,Alternate Facility(or Generator) <br /> U j <br /> w Facility's Phone: Month Dsy' Yaar <br /> 18c.SignalureofNlemate Facility(orGenoralor) <br /> 4 <br /> Z <br /> ig.Hazardous Waste Report Management Meuwd!Cod s(Le.,codes for hazardous waste treatment,disposal;and recycling systems) 4 <br /> L 1 2. 8. <br /> At <br /> 20.O. ..... le Fa ill nor r rater. fication f re iptor haxardous�terials cove ed by the manifest except need in lie. a < <br /> Pr dlTyped Na Signature r r Month Day Yea <br /> D GNAT ;✓A <br /> EPA Form 8700-22(Rev,3,05) Previous editionsjare bsol�t , 11ri T �� 11IiA1 t0H <br />