Laserfiche WebLink
M (n -0o0 <br /> (D 2M' O <br /> N <br /> ::3 -0 v <br /> O 0110 <br /> �# C (D <br /> TI G <br /> O <br /> O � � COO <br /> Q <br /> O O PQ <br /> A 3 w <br /> M <br /> VR�Y00 <br /> Please print or type.(Form des!n <br /> 9 ad for use on elite(1?-pitch)typawnferJ I N <br /> UNIFORM NA7ARD TUB 1.Generator lO Number Form (.7l <br /> WASTE AIANIFAnd Page 10l ].Emergency Neapoase prwna a iiiiii Trsekm Names oMe No.205G-ppae (� <br /> 11yy , 5-GenemtoraName andMaliEng'dresy - _ OQ8�80589 FLE <br /> / - eneab s ane re.a prd�rtere ti gun rnellmg e9e } <br /> J <br /> 12 11 - 7 -e # <br /> nriv5 <br /> Gene _ t' <br /> S. DNumeer <br /> 7 T.msp0m,2 Canpany Name - _ 3 <br /> V,!E AID umbal <br /> e.Designated Facfliry Name and Sill tl , let Cent:.lt'V EMN, LC D <br /> U.Fall Apne- 5�:410 G.EPAID umbra <br /> mer"n �v, NV $°yv09 5D <br /> yy r <br /> II ga. 96,U.S.DOT Cesnd0on(inciiing Paper Shipping Name,Mmard Class,ID Number, 10 Combine. <br /> r � <br /> HM and Parking Gmap fff any)) 11.Tmal ' 12.Unit 13-v+9ere Cartes 7 <br /> No, Type Cuantily wuvd. <br /> 1{JN3 -;6, Waste Carrnsiva 1]g1rh, Dasic, 1 CFti_,eji» (D <br /> 1.'Cru.3n)r. Ir.o. '"CaI�I n f' nc i- l� GdvS� 0 <br /> �a],1 is <br /> Car burateJ 8. r, Ii Et�G#154 <br /> . 2 <br /> � 1JN1950, Waste Aerosol,, ft3mmable �,1, EAG#ISG 1 CFn <br /> 71, Cz+01 D <br /> a. <br /> 4. <br /> 14.Special Handling Inslnrcfions antlgAdiaonal Inlwmalion <br /> ! 3.1@a�J45(Lp3�ic Liquid_, Ccrtmsivei "10084�rAero_n?<_� <br /> T 15. GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby denlare Vial file contents oithis consignment are Polly and accurately described above byte proper shipping name,and are classified,packaged <br /> marked and labeler,plawMed,and are in all respects in propercondilion lw transport according m applicable inlematonal and nationalovemrnental <br /> '�.:. Fxpoder,I cerary that the contents of this consignment conform to Ve terms of the avached EPAAcknowledgment of Consent. $ regulations-If expod shipment and I am the Primary <br /> I ceAfy that the waste minimization statement identified in 40 CFR 262.27(a)(Af am a large gvanfily genemlor)or(b)(d I am a small guanfi enera[or)is hve. <br /> Gen to rots PdnredlTyped Name <br /> gra r <br /> C on Lay ear <br /> 1 fnlemav S en �(.V— y _ - <br /> 2 ❑ <br /> Import to U.S. <br /> Trans der sr nature 161.witteari F_xportfro U.S. Port olentry! ' <br /> W17 Transporte,ArkrrowlevidgmenlafReceipldMaterials tel V.S.; <br /> Transporter 1 Pdnted?yped Name <br /> O 9 lu on <br /> A r7ntNonv Mack y <br /> Q <br /> z 7ramporkr2Pnnted/rypi:Name <br /> _ <br /> y. IgnaWre }� 'l <br /> t— oN h ay <br /> 18.Discrepancy <br /> ';. 18a.Discrepancy Indication Space <br /> ❑Quandty ❑Type ❑ <br /> ❑Residue partial R <br /> ❑ ejection FuN Rajecoon <br /> 18b.Altemate Faltildy(or Generator) Manifest Reference Number <br /> `r <br /> U lf.S.EPAID Number <br /> a <br /> LL Fadh a phone: <br /> F16c,$1gnaPore ofAftemate Fatlfity(or Generator) <br /> Q <br /> - Z Month Dey Year <br /> }$,Haardmrs N'aste Report Mareeeme:l!Sethcd Cods(i.�.,elides bur hazardous Waste treatment,disposal,and recycling systems) <br /> a 1. <br /> 2 3. <br /> lin <br /> DesignatedTypodNFaaldy Omer or pperator,Ce tification ofrecelpl othazardous materials covered by the manifest except as noted in them 18a <br /> ! PrinleNTy�Name <br /> r <br /> /, -, Signature Month Dey Year <br /> EPA Form 870422(Rev.3-0SJ Previous editions ae-obsolete. (h� 3 C O <br /> n <br /> DESIGNATED FACILITY TO DESTINATION STATE of REQUIRED) D a <br /> CSD N <br /> (� O <br /> O W <br /> CST (0 <br /> CST <br />