Laserfiche WebLink
ATTACHMENT E <br /> Please print or type (Fcrm designed for use on elite ( 12•pitch) typewriter.) Furm Auproved . OMB No 2050 0 , 3q <br /> UNIFORM HAZARDOUS 1 , Generator 10 Number 2 Fags I of 3 Emergency Responso Plane 4 , Manifest Trraa]ckir Number <br /> WASTE MANIFEST � >�� ( 141WMS"rn5 U U .J ..J .1.. bm i J .3 FLE <br /> Gei era:o 's tJhnr mnd tJawn9Arldress Gerxrators Address Onl Iflatt mMing address) <br /> WSW Cftbfd <br /> AtA io <br /> YA>W <br /> Generawii Phone: <br /> b rensporler 1 mpany eme U S . EPA ID Nurrber <br /> A&Wvoed Clweci TnnrW Inc . OV) CARD0097OW <br /> 7 Transporter 2 Company eme U.S EPA ID Number <br /> y Designaled Fac4ty Name end SiteAddiless US EPA 10 Number <br /> 6133 *9)0022=7 <br /> bpi W <br /> Fa s Pham: <br /> a 9b U S DOT Descroon (6ufdY+g Proper Shipping Name. Hazard Clew ID Number, I Gur pil curs 11 . Tota' 12 Ur :t <br /> and Padomg Grow (11 any)} %,: Type Quantify vit ,%ro . 3 Ylasta Codes <br /> o I <br /> No*-RCRA HwAkkx s Wave SaW (ay SaW ; y� , I -) � = <br /> w <br /> w <br /> z <br /> I I <br /> i <br /> a Spatial Hendtrq ins nxions and Add Inform <br /> a/j pflow PAWAV , i o ii'. . . turd R It"W87 <br /> cn <br /> 1 ) � S.vw►�.—.__D - <br /> V/Af <br /> GENERATOR 'S OFFEROR' S CERTIFICATION : I hereby declare that Oe cattems of INS con"ninent are fuCy and acaxateiy descroed aMve by the propershipwig name, and are dassibed. packaged. <br /> Ta' ''C J arQ ,h_ c'J (:' a -6rJe1 : ' . J .: !a � . rc<_Feas in proper cor4aw for transport acw*r-g to app "&e mtemalwai and naiwnal governmental reguiaoons If export shpment and I am the Pnmary <br /> Exporter, I Certfy that dte contends of this oorrsq' wi to u'e terms of the attached EPAAcknowtedgment of Consent. <br /> I ce+% that the waste mirimitation statement idenbW in 40 CFR 262 271a) (41 am a wi;e quantity generator) of (b) (if I am a small quantity generator) d true <br /> , : avatars arts nnr yped eme ure17 <br /> J <br /> . y <br /> f` tyy i kit <br /> i I F ternataUl pmeMs t�l <br /> z ❑ krtport b U S L 7 Export 6om U 5. Pal of eNryb+re - <br /> Tr,tnsower signature re (fa exports onlyl! Dots gamy U.S.: <br /> w 17 TransWer Acuv*Wgrr erd of R t of Mauls <br /> ItMer <br /> rl9w VICIt eZIRLM 11 10)OW <br /> Q 'q.mspoder 2 Pdmled'Typed Name ay Yeae <br /> F- <br /> 18 Discrepancy <br /> B;r. Dwepancy Indloatcm Space ❑ cluffayr ❑ Type Redue ❑ Partial Re <br /> eon LJ Ful Res: on <br /> Manifest Reference Number. <br /> FL 1bu . A' :ernaioFaolly (or Generetorl U.S. EPA ID Number <br /> J <br /> U <br /> a <br /> u Fa <br /> cA 's Phone; <br /> O LLJIdc Sgnatue dMemete Facility fa Generator} Idontn y Year <br /> 4 <br /> 2 <br /> 3U f9 Hazardous Waste Fad Management Method Codas (i e , codes for hazardous waste nee em, disposal, andt" Systems] <br /> w 2 3 4 <br /> jell I <br /> Z0 Designated Fw* O*rw or Oprifilot, CerKtabon of of hazaedous maMttals c9vated by the rranaesi except as noted in Rem 163 <br /> P I ypedN�ww / Mono 0 ay Year <br /> y f <br /> EPA Form 8700-22 (Rev* 3.05) Previous editions are obsolete, — DF SI NATFOFACILITYTOGENERATOR <br />