Laserfiche WebLink
� <br /> Please print or type.(Form designed for use on elito L11,-pitch)typewriter,) Form Ipprovecl.OMB No.2050 <br /> Generator ID Number 2,Page jo t &Emergency Response Phone 4,Monifost1racking Number <br /> MANIFEST <br /> 41 "257901 SKS <br /> UNIF9,RM HAZARDOUS <br /> WASTE NIFEU ; nnS <br /> -5,—ooneratoes Name and Malllrvg Address Generators Site Address(if different than moiling Address) <br /> :7 <br /> G,refat()N Phone, <br /> S.EPA ID Number <br /> 6.Transporter 1 CompanyAhMe <br /> U.S. PAIDNumber <br /> 7.Transporter 2 Company Name <br /> U,S,EPA IQ Number <br /> 8.Designated facility Name and Site Address <br /> a' <br /> to'! ;6ftp,""'-ALT <br /> Facility's Phone: J - <br /> 9b.U.S.DoT Description(induding Proper Ship Ing Name,Hazard Class,ID Number,-,, io.containers li.Tblal 12.Unit 13,Waste Codes <br /> ga. Quantity Wt,Nol, <br /> HM and Packing Group(if any)) No. Type <br /> 0 <br /> 2, <br /> W <br /> 4, <br /> 14,Special Handling Instructions and Additional InflotmaJon <br /> R <br /> are classified,Ing name,and r ris,ifiad,pa6ag <br /> W1Aj ltrl a Prlmrl�j.' <br /> tafr <br /> -ERb9?S'-9k shipmentand I am the Prime <br /> national governmental regulations.if export <br /> marked and labelsdfplacarded,and ate In all rasp cts In'proper condition for transport according tolapplicallIs Intemallonalarid <br /> gnr lent conform to the terms of the attached EFAA6nowledgment of Consent; <br /> Exporterf I cortify that the contents of this consign <br /> I c*dIfy that the waste minimization statemeniider tilled in 40 CFR 26227(0)(if(am a large quengly.generator)or(b)(ifl.sm a smallIquantily ganoreto0a true. Month Day <br /> ......... Year <br /> 7 <br /> PrIntediTyped�Namo I <br /> I— 16,International Shipmen'ts <br /> Import to <br /> Export from U.S.. Pon of entry/exit: <br /> Transporter signature(for exports oniv): Date leaving U'8' <br /> : <br /> cd 17,Transporter AcknoWWgmenfOfReedPtOfMalvild'3 Month Day Year <br /> i 'i� iI I I-"c Name D <br /> 0t. <br /> CA. Month yeay <br /> 81linatulo <br /> Ttansjiodr# Ye��d�- . Nlifi�' � <br /> io.Discrepancy <br /> ❑ Residue FIP,N,l Rejection ❑Full Rejection <br /> 18a.Discrepancy Indication Space D ciuentft� Type ❑ <br /> MahirestReferonce Number; <br /> U.S.EPA ID Number <br /> 16 Alternate Facility(or Generator)' <br /> 't tFacility's Phone: <br /> L Month D4 Year <br /> 18c,Signature of Alto Facility(or Gonorator)� <br /> N <br /> Facility(0,Generate) <br /> -sc'l' -sphone' <br /> Signature A I <br /> 19r. "0 tom t <br /> tM JK d Cc ns) <br /> m a g syster <br /> an.g. a', <br /> Hazardous W t R I I M_ <br /> 19. Waste Report Management MeWd Codes Q,o,codes for hazardous waste treatment;disposal,and recycifn <br /> 4, <br /> W1. <br /> 90.Desionaled Facility Dr�"no,of Operator":CeAlf,�6cajlc n of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> on h DaY Year <br /> Pn'ntedffypad Name S nature <br /> GEN OR'S INITIAL COPY <br /> EPA Form 8700.22(Rev.3.05) Previous edition$ar obsolete. <br />