Laserfiche WebLink
v - <br /> NON-HAZARDOUS 1 G--e-1' '�- � 2 Page 1 cr 3 c—er,e yes[•:^x P7-^e A.Waste Tract n Num1m <br /> WASTE MANIFEST �. <br /> 5 Genz a;xs'la—,e aril ftraamg A»e55 V/ L GP^P'aVr;j to- ,cs i•1'erert t^•--afmg ajressi <br /> Grsr3•c•s DnCte � <br /> 5 trarsporr t s-;ary^ir v S E%AID Ni^^e <br /> 1C E> Lfnf'x 6(k <br /> 7 'ransMrM 2 C?n[znY Name U S EPA ID N.rber <br /> 9 Des g^a %ac:y t:a—r am Sre Address YaO US Era ID Nwrcer <br /> Fact''s P-�o^e <br /> tD Corta-mrs I1 Total '2 Unit <br /> 9 '2las'e Sn•;r�rla'ne a^:Descnpton 'lo T�t Cuannty �`.:Vnl <br /> ri <br /> W <br /> Z <br /> W <br /> 3, <br /> 4 <br /> 13 Special Hanging Irts1,L0015 and Add lional hlormaoon <br /> 14.GENERATOR'S CERTIFICATION; I certiy t.'te mafmiass de`scr�ibed above on his manllesl are not subjiml to federal rWarons for repo•tng me,dismsal Of HaZar]Ous Vjasie <br /> General • '0sPnn! T/�qv �,�/�"�`� Sgnalure t.tnnm DaY yr:;• <br /> �a <br /> 15.InterrM."I Snorers ❑Imoort to U S ❑Export from U.S Port of ent^ylext <br /> i— <br /> Transrorier Sqnalule dor elporls only) Da!e leaynq U S. <br /> cc 16 Tran%W.er Ackncwled¢nerd of Receipt Of Mafenas <br /> rr Transporter 1 PnrterlTypedNar+e Signator / f.lprth Day r'ea• <br /> N i0 o •? ��, <br /> a <br /> a T•ansporter2PrntedTymdN•ne Sgnatute 61r,,rh Da, rc]r <br /> rs <br /> 17 Dscrepaxy <br /> 17a D•sc•epancy Indication Some <br /> ❑(hrantdy El Type ❑Resi4,,e ❑Pa:-.al Refect m ❑Full Pe;?c'ion <br /> Mardest Reference Nunter. <br /> y 17b Alrema!e Facility jor Gsneratori US EPA ID Nimtter <br /> r <br /> J <br /> J <br /> a Faal 's Phone <br /> 17c.S gnanm of AI!e nate Fanlay ja Ge7erataj <br /> Du Ya?, <br /> 2 <br /> 7 <br /> 7 <br /> a Des a' F it!y Owne•or Cperaar Ce'l4abm d receipt d materials crovered by 7+e mandesl except as noted it 1' <br /> Pnn! ed a e Sg�ti <br /> Scanned with CamScanner <br />