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18b. AtteMidefacility (cir Generator)
<br />Fairility's Ph*
<br />18c: Sitinature ofAltematafacIlity (ot Gerierator) :o . , ..‘.
<br />19: Hazardous Waste Repart Managemeat Method Codes (i.e., 040 for. iiaZiardthiawaste teafinant; disikeali and fecyc)irig Sifste.mn)j: '
<br />20.. signiteilFaCtittp?iner OOP rator.; itificatiOmof receipt of ha •ciusmaferialS.Oovered:bi:the maniiest except as 'ffein18a
<br />- EPA Form 870,092 Nev.:1 711) PfeviOgs .editions are obsoletei • ••
<br />U.S. EPAICNiirnboar
<br />DESIGNATED FACILITYTD GENERA
<br />.Fonri AO-roved: pme wo.29spzoo39 . PleS.prirtype.
<br />2. 13470 lot Emargency FtespOnse•Phorie,.. .; ,pN100121(kpiTARDOUS
<br />WASTEVANIFEST
<br />1. Generator ID Number
<br />.<7,4C 00 tO4 9 9 )
<br />4.'MarilfentTriticking.NuMber,- .:actele.-4682
<br />5,.Generateeeo Name and Mailing Address
<br />éheratosP'one:'
<br />6,. Imm7' or I- ciarripaoY Name 4
<br />':''''' • Asr(40414-'
<br />T_Trans#* COMPany,Narae...
<br />:$4 j
<br />8,
<br />IOU
<br />Designat Facility-WA) Acidr
<br />YA
<br />ittOr4i ;,.lii,
<br />CASA" ' 1 1,7604
<br />,::61';;Ii;ii(;;;,/ ).twe- I :CA'. • .. cr.• •
<br />. gas
<br />HriA
<br />I information
<br />pi 6. IntetriatIonal Shipments •,•• • . D
<br />Pair4i°16,40.t401; (for
<br />10104"*.k**00th0 lal*eiPt Of P.A*Olt
<br />.T(ariSPOilar1.Printed/1yPd5Hanip
<br />2 P-Oted/TyPed Name : •
<br />18. biscr6pan4y
<br />18a. Diatregity Indication Space'- 17:71 Quantity
<br />,11.total
<br />Quantity
<br />arardjásifiedpackftped,•
<br />IprnentanithdPçIma'
<br />- •
<br />likto Day
<br />46.11 ,14 ,44*.
<br />Mntl
<br />4
<br />JItI
<br />•
<br />Residtie =
<br />Mariffentkikerence NUmbee
<br />eitor 40e
<br />411--
<br />bsvô'44.ese7, 6,4a .5 fro a TV" a,
<br />K$ V. I/ 1'4'5 L311 Y5ikitr C c IS-
<br />okAtryeA/G-reve,etywne
<br />GeneratorlsSiteAddresa (if:different than mailing ,address)
<br />:U.S.EPA ID Number 69e0142:13‘joy-
<br />ielAt: 604101014.1614t
<br />0;8 9r/i ej .09'.4 ,
<br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number', •
<br />and Packing Group (it any)) • No. =
<br />..14,..$peOlal Handling Instructions.. arid ..
<br />-:.1`y, t..1:1•'..0 . , . • •
<br />
<br />15 gNE401-9Fr.pcofFc.),.s.cppl.FicTi.cpi.:.-Ihereby.diaclaritithat.thetrintedis Fifo this consignineataraifully, aridAccyrritnidoitscribed alinWitgrtheoOper:Shippldgona,
<br />raMdct and .10,1041apaNel,••ahd. are In Off reapeCts•in proper Condition for•trartapert..acOardfngloapplidable•Internattijnal aripl.iii‘IldfillAWitffmentakra0Intfon.n.'ffnportl.
<br />'Eip`ortni,1 certlff that the contents of this consignment conform to the terms Of the attached EPAAclido*Indginent of Consent :P ' "••••"'• : „., . :•"":”
<br />
<br />oI certify that the Waste'.rdinirafzatiOn statement identified in 40 CF,R,•262.27(a) (If ram a, large Miantitynerieritor) or (b) (if 1.0 a small cidantity.genorator) sirue: 4,6e •11
<br />onth W.,' :year, .,• , • . qarotators7Pfrapes Prihted/TYped Name , :$,X180.ttlfir.
<br />,14
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