Laserfiche WebLink
800 W. Mossdale Rd. Record ID# PR0514467 <br /> 8/5/2020 Program: HW <br /> Photo 12: The following uniform hazardous waste manifest(017792014JJK) observed with no signed copy from designated facility. <br /> y resigned Fur use an elite 12-pitch)lypewdler- Fmm Approval.OsiG No.25"233 <br /> - D "1"77 <br /> Number 2.Page I or 7.Enwrgency Rssponse Phone 1,Mandan)Tr'a`cpking NumMr q� 1 �( <br /> MANIFEST - ..'1 �':j 1 rl',7 LSI.!r3 JJK <br /> f' islets Name and M.,hng 0.dtlres5 Gar.a,glOxS Sie adl—V d attemM than mailing atltl:ase} <br /> G¢nelatNS phone. - <br /> 6.Tmnspaner 1 Company Nam. N 5 EFS;e N,rmLe: � <br /> r+ 1TmnsporrcrgGompery Name us EPA gNumber <br /> u i <br /> T <br /> 9 B D"-1- 111 Namend. Site Address LLS.FPAIDTI1— <br /> 11111•`1 INC <br /> P <br /> 9,1 U.S.DCTrtaaxno"'Imcudirg ProperShmpmg Name.Hazard Cass.lUNumher, In romiirlam 11 To' 12 Una 1g'uYaslx Codes <br /> HM antl Packing Gmup Iifarryl) N. 7yp a.Uy WI.W xxJ <br /> f.., <br /> 0 <br /> PART � - <br /> w <br /> a. <br /> CASH F la-spas l"sMmqInelft dA.dde-1 lnro—ft, <br /> N r -u I'•'la.rl Hi II I•ki1::JfyRE Pkia7FLIlYE.FQU;MME.W1 y �� <br /> 15. GENEAATGR'SIOFFEROR'a CERTIFICATIGN:rherebytlxlare Inst Na eonlenl5 of this tnnsgnmenl.re fully and acwralely described above by the proper sNrgglrg rtarne,am ere dasufred,packaged. <br /> L. <br /> packaged.-* and are inallre.peasm proper—dllion foo@anapod according to applicable International aM national governmental Egiladons.11 expan shtpmenl antl Ism Na Pmnary <br /> E Faporter,l artilymal Ne rarK. aflha.1slgnmanl mnlormbthelerrlla bflh9 attached EPAAoknw W9-nLof Co-1t <br /> I C061y Nat rhe waste mmimizahon stale—W.ndfiad In 40CFR 262,27(a}iiil am a large quantity generelorl or lbl)III em a small quandly,ganaramr)a W. <br /> Genets IsII]e er Prinle&Typed Name Slgnatute hlenth Day tear <br /> 6RI1H J 1s INerrraudna15hipments <br /> � ❑Impart to U.S. ❑Export lrom US. PortINernrylexR._ ---- <br /> Date leavI"g U.S., <br /> Transporter signawre poi eapoM1S onlyJ: <br /> Trane dd1Aaknrnrfadgmenl elNareipl ofMaledels" <br /> J ar atm^ Trarrspartar f P 011.Ryped Name.. _ nature f - Day 'I <br /> r xn Signature Monty Day <br /> dillI A Tran5porte0PnnradlTyped Hame <br /> the sp <br /> r <br /> r <br /> �... <br /> ha I I 1a o'-apanoy <br /> I 18x.Discrepanry ll Space ❑Quanllly ❑Type ❑Resld. ❑P.Na1 Rslatnon ❑Fug RiNeodon <br /> fll MBNfest Relamnce Number, <br /> Alf.m.le FerJYly(pr Ge neral or US EPAIU Numom 1 <br /> J <br /> U S <br /> LL Fa0Vl Phono <br /> 18c.Signature olAlfemete Faculty for Genereta) Morgh lay Year <br /> a <br /> rm z <br /> 19.Hazardous Waste Repon Management MoWd Codes(l e,,codes for hazardous waste treatment,disposal,and recytlll eyeleme) <br /> d o 1 2. 3. 4 <br /> 20 Daelgneled Fsclliry Owner or Operator Certlncauen of recafpi of hazardous materials covered by the manifest except ee noted In Item 10a <br /> I' f Cu Frinm p ams Mmh Day ear <br /> i -- <br /> Pr EPA Form 8700-22(Rev.3-05)Previous edllbria are obsolete. GENERATOR'S INITIAL COPY <br /> . a <br /> JASON GAITAN, EHS Page 12 of 21 <br />