Laserfiche WebLink
"��'�""��� <br /> Please print or type. Farm Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I-GoneratorlDlNlumber 2.Page I of ErITM Response Phone 4.10ITrack! Number <br /> WAIII MANIFIESI d6 <br /> 29257 FLE <br /> 5.Generators Name and Melling Address Generator's Site Address(if different than mailing address) <br /> Generators Phona: s. � <br /> 6.Transporter 1 Company Nam <br /> U.S.EPA ID Nurtder <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated F*Nam and Site Address,, U.S.EPA ID Number <br /> i',7 <br /> Phones—,-6 E 4 e 8 9 3 a <br /> ga. 9b-U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11 Total 12.Unit <br /> HM and Packing Croup(if any)) 13,Waste Codes <br /> No. Type Quantity WLAtol. <br /> 2. <br /> ul <br /> 3, <br /> 4. <br /> 14 Special Handling instructions and Additional Information "ZI -7 3 4, <br /> 15. GENERATOR'SWFEROWS CERTIFICATION:I hereby declare that ft 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 intemationaland national governmental regulations,If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of gQpsent <br /> I cerldy that the waste minimi;iu�slaiement identified in 40 CFR 262,27(a)(N I am a large quantity generator)or (it am a small quMRj46QaIor)!j Inue, <br /> r OWC, fir <br /> Gen btPrinNdTyped Np* Moo Day Year <br /> J 16.rarnational Shilim" <br /> F— 0 w,,w W U.S. ❑E-pon fromU.& of "t an 1 <br /> :1 Transporter skinalure(for exports only): �t-leall U,S-. <br /> W 17. oReceipt of Materials <br /> L" f <br /> i2 Transporter I Fyi;�ypd Name Month Day Year <br /> 0 <br /> 5- 4nthany Macn< TA A J Y 0, i55 <br /> co <br /> z Transporter 2 P*, Month Day Year <br /> 18a,Discrepancy Wicabon Spam 0 Quantity ❑Type L J Residue El Partial Reaction ❑Full Rejection <br /> Manifest Reference Number: <br /> i8b-Akernate Facility(or Generator) U.S.EPA ID Number <br /> LL. Facility's Phone: <br /> 16c.Signature of Alternate Facility(or Generator) Month Day' Year <br /> Z <br /> 0 <br /> aS 19.HazardousViVasle Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> C3LU <br /> 1 2, <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in*m 18a <br /> Printedayped Nam 96 I goature Month My Year <br /> (A <br /> rA1V 9 YI& 27 ITI 1 Vap <br /> EPA Form 8700-22(Rev,12-17) Previous editions are obsolete. ESIGNA7 Q AGILITY TO EPA's e-MANIFEST SYSTEM <br />