Laserfiche WebLink
0 0 6 1 3 6 8 2 1 3 K S <br /> Please print or type,(Form designed for use on elite(12-pitch)typewriter.) Form approved.QM8 No.2€050. 039 <br /> UNIFORM HAZARDOUS 1'Gerseratar iD l4umber 2.Page t of 3.Emergency Response F-", 9.ManifesttTracicfng NuAgw <br /> WASTE MANIFEST 1006136821 SKS <br /> Gooeratoft Norm and Mail#g Address GeneraWs Site Address Cit d%rand it fi mji ng gess) <br /> Generahn's Phone: <br /> 8.Transputer t Ca rrpaey NalmU.S.EPA ID Norn6ar <br /> T.Tronsperter 2 Compaq Nance <br /> U.S.EPA K]Number <br /> B.Dasigratedd fadli!y Narnne and Site Address <br /> U.S.EPA ICJ Number <br /> F&Wy's PW%e: <br /> 98. 9b.J.S.DOT Desuoion(includng Proper Si W,'q Name,Hazard Class,ID Number. 10.Cor aaiaets 11.Total 12.tint <br /> FIM aw P00419 Group(f any); 13 Waste Codes <br /> No. Type Quantity WL1Vd. <br /> F� S'..t4ri•C:.4 j�`: x+#{�+`� i.i �"f"F._fit? <br /> t i <br /> 3. <br /> i <br /> i <br /> i <br /> d. <br /> F <br /> ) <br /> 4.Specie!Ha"invuetisans and Additional tnformation <br /> 15. GOtERATOR` OFFEROR'S CERTIFICATION: l"hereby dedere!hat the Ments of flus oamsig^: *ntire tufty and accurately described abwe by the Voper s6 name,vVa e otass?%d.packaged. <br /> marked afld labeledfpfaeantad,and era in a8 respects m prpper oondit on for transport accorditf9 i tg pt Cafe iMemational and nakmaf gmemmer#fat reg6abons.If ax¢Ort shp;nerr:81?d t am the Prirrwy <br /> Exiwrtor.F'Wtify that the ODMents otttwconsigrwW4 confwrn to ft lawns of the atlaoed EPAAc€unravte#tgmeni of Consent. <br /> I cs*that the waste m"iz-Aiat statetwnl identtfusd in 40 CFR 262.27(a)(it i am a large gu mly generator)or{q)(if I am a small Guan(ify genearator)is here. <br /> Gee etotsfOfferorsPrintedrYypedA€arta Sgnalum Month flay. <br /> J $,itdaprtab�fai !tts + <br /> ❑hr"at to U.S. ❑Expo from U.S. Portof anwexk <br /> Transporter sj9nattma(for amts a* Date caving U.S.: <br /> ??,T€anapWa A0wawl*yil !rat Reowr3f matan s <br /> UA <br /> T .s er 1 Pr:'nted' ?lama Signature Month Day / <br /> Tran 2 ntsdr`yped Nam& 5gnature [lay Year <br /> ±�#i <br /> 18.D srrapanry <br /> 16a.Discrepaney ind cation Space El Quam ryr C Type ❑Residue Partial Re erxian Q Fut Re,..d#t <br /> Manifest Reference Winter: <br /> 1Bb-Aftemete Faakty for Generator) U.S.EPA lD Number <br /> C� <br /> 18c.8ignah,re M&WRia FacBity tot G8wata:) 11 tx + Day Year <br /> 1� <br /> d <br /> 15,HazardoA WeAe Reprxt Masnagernent Method Codes(Le.,Codes la hantr=' waste lreatmerrt,dousal:and facycfrng systems) <br /> t. 2. 3. IT- <br /> . . <br /> Designated Farl-V Chafer nr Operator:Ceaflca 61 of MW of tezardous rrat?riais cowered by the manKsl except as nded is ham 18a <br /> tdarr a ( h1onth Day `sear <br /> EPA Form 8700- u. } re editions are oKoleta, t� �s. a e Sf' z 3's S't")NATJO STATE(IF:tREQLJIREO) <br />