Laserfiche WebLink
M cn M cn <br /> (D =� o3 <br /> m O v <br /> (D ONo Ro <br /> 0 C <br /> o (n in w <br /> a — <br /> o <br /> �7 3 o <br /> M 3 w <br /> C/) C <br /> Nlonan Ndnf ori rte. Form desired frrt <br /> ��� �,w,anr, IIIIIlIlllflll <br /> UNIFORM HAZARDOu! .U.:ri�;,,,�„n r Ii � Z <br /> WA9TF MgNlp(:8T <br /> rl.'i�i��art en2 mfr 2 aael a. rner pr Earm 011! <br /> ' � na(n r.11p rnp rM, 0 <br /> 1,:•rmrnlar'a Fhrun• r r r <br /> nneps ort umpeny emn <br /> 1 rinnepMlef empeny ,no <br /> Signaled enilly -"--and to d+ane q.S AI Nvmher O <br /> U S EPA IG Nigpnr 77 <br /> F-Ji'S Phono. 0 <br /> 9a. Bb lL50iir ln-��npb'rnfiucb.uilnA Praf,nr8hlpping Namn,Hetard r;ln-..Ib Hurnb.r <br /> HM and P;n'h inn r;r„rrr•IJ.nrVll r <br /> inn amer. <br /> P ra' Type r—Itt, <br /> CL <br /> 1 � O <br /> a <br /> i <br /> n = <br /> 7 <br /> O <br /> 14.Special Handling 1nslrucliens end AUUiponai inlnrmation Is <br /> • <br /> w <br /> 15. GENERATORbe.djjEROR'S CERTIFICA710N:Thereby dnUare that the conranls rH tl,re consignment are hilly and accurately descnhed above the <br /> marked and labeled/placardmd,an of In,re all respects in proper condition Mr Vanspon according to apphcablfully '8i Mand national ovemmeMal 1: aOons Wing <br /> and eroa�� ti <br /> Eapoder,loen'rty lhal the Ppnlenls of this consignmenlconbrmtothelefmseflheallached EPAAcknoMedgmentol Consent. g reAu "p°o u"p"1e1r and lam the w'n'Sry <br /> I cedify thal the waste minimieation slatemenl idenli6ed in 40 CFR 262 27(a){il I am a large quangly generamq rn(b)(if am a small quantity , <br /> eneralo eros fmle yp ame g ygeneramp mane 7 <br /> Igna ure IIQ <br /> on av ey � <br /> 16.inrernational5hipmenls <br /> ElII��I_I 10 <br /> Impud to US Export Imm U.S. Pon of enlryM,.,t <br /> = Trans orlersl nature form... <br /> onl <br /> w <br /> I7.TranspoOrAcknowledgmenlof Recelptof Maleriats bate leavin U.S.: <br /> Tradepoder 1 Printed ypad Name a aA ea' <br /> rn <br /> 9 z Transporter 2 Printe?yped Name Ignawre <br /> n a, s'ea, <br /> Itl.Discrepancy C <br /> f <br /> 169 UrsGepancy Indication Space ❑ T Quantity <br /> ype LJ Residue ❑Partial Relac6on ❑FIA Relecoon <br /> lOb.Alternale Facility for Generator) Manliest Reference Number. <br /> � IJ 5 EPA ID Number <br /> U <br /> Fablil's Phone: <br /> W 16c.Signature of Allernate Facilay(or Generator) <br /> Q Month Day year <br /> z <br /> N19.Hazardous Waste Report Managamenl Method Codes(ie,Odes for hazardous waste Ireatmont.disposal,and recycling systems) <br /> 1, 2, 3. <br /> 4 <br /> 20 Deaignafed Facifly Owner cr Operator:Canificalior of mcmlpt of hazardous materials covered by the manifesl eacepl as noted In Item 16a C (D <br /> dIMyped Name n <br /> SignaWre <br /> Monro Day veer D Q <br /> I _ <br /> EPA Form 8700.22(Rev.3.05)Previous editions are obsolete. = p <br /> GENERATOR'S INITIAL COPY v <br /> CD <br /> N <br /> O <br /> O Cl)UI <br /> (0 <br /> (D W <br /> W v <br /> v 00 <br />