Laserfiche WebLink
u ..,7If 1IIIBIIIIIIIbI��fllNl�llll <br /> 0072757793 KS <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> 1.Generator 10 Numher g_-.- _ 2. age 3. me R eP CManifest Tracking Number <br /> UNIFORM HAZARDOUS .C4S 9L_n[s.=:' ,•7;'7c. € i TF'I 0 0 7 2 7 5 713 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> If 74�7 <br /> -1v , <br /> Generators Phone: - <br /> 6.TrWsppt4af4Comp<Tny,H�lp@ r r:.1� ha U.S.EPA ID Number <br /> T e._. ".h. <br /> 7.Tmnsporter2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address r-t F-AN `ARROPPS -^,cal ".F U.S.EPA ID Number <br /> rreF <br /> Facility's Phone: <br /> ga 91h.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantil Wuvoif <br /> r 1 c r z r n (�. -r't <br /> } hl* .S r F, f?hj'4FI,F L IT nE 'n P �P •= <br /> Q YY F IL' M jJ7F7i,f <br /> z 2. <br /> 3. <br /> 4. <br /> 14 Special Handling Instructions and Additional Intonation <br /> , { .f.ri <br /> ,,., �hn.n <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.Nexpat shipment and I am the Primary <br /> Exporter,I certify that the contends of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)o (if I am a small qua era r)is true. <br /> Gen I1 erorlill., /Typed f j /w !'^ S atur Month Year <br /> 16.International Shipments F/� /\ 2 . <br /> F 1:1Import to U.S. F-1Exportfrom U.S, Part of entrylexit: <br /> 3 Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> K Trans rt I Pmrdedl a Signature Mongr Day Yea <br /> a <br /> QTran2 Prin (typed Name Signature Month Day Year <br /> F Z <br /> 18.iliscrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) - U.S.EPA ID Number <br /> J <br /> > _ <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazaraous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20.Designated Facility DIrer or Operator Certification of new' f hazardous materials covered by the manifest ex as n in a <br /> Pridedliype ame Signa Month Day _ Year <br /> EPA Form 870022(Rev.12-17) Previous edt6 aToobsol .���� r DES AT ITY TOEPA's e-MANIFEST SYSTEM <br />