Laserfiche WebLink
Nov 15 2008 1:23PM HP LASERJET FAX P.3 <br />Al <br />1 1e85e prirt or type. foam dpsi nerd for use on a to (12-o Ich)..i waiter. Form Approved. OARS No. 2050,. B ,! <br />UNFORM HArEARDOOS 1- Generator ID Number <br />+� �, <br />q(800)424 <br />2 Page 1 of <br />3: Emergency Response PhoneMenlo <br />T;ww—g umbar. ' <br />J <br />WASE MANIFEST: R o <br />-0;Q0 <br />+ <br />5.G (ormeMRI Add er <br />Gyrator'sSleAddress'(Ifddferanithan mailing address) <br />i <br />SWIM T. <br />y <br />W O�i�' O? <br />FWBVAitA3S-581 <br />Generates P ne: <br />� ) a <br />B. Transporler .� ray Name <br />T <br />J �- &> d.. UA I umber <br />'� <br />t1 <br />on <br />7. Transporter 2 pang Name <br />U.S. EPA D Numm <br />8. Desi®nota e pp yr <br />U.S. EPA D Number <br />- <br />C A T 0 0 a .4.E 1 1 7 <br />Paclt s Phone: <br />ga. <br />gb• U.S, DOT Deaoiptlon (Indu irtg Proper Shipping Tian <br />%Hazard Class, ID Humber, <br />10: Containers <br />91, Tod <br />12• Unit. <br />13. Waste codes <br />NO. <br />Type <br />HM <br />ard.'addig Gftrp (if ani. <br />Quantity <br />wlJVal.... <br />$ii <br />._ <br />O <br />.� <br />x <br />CA301275- <br />41 <br />t.7 <br />- <br />14. pedes Handling Inshuctions and Additional Infomra6en <br />i <br />C15. <br />1. <br />GENER4TORWOFPEROWS CERMCA711i I h;:reby <br />that the contents of this consWnment are fully and accuretoly described above by the pow sNp$V nonce, and are classified, packaged, <br />�. <br />mad* and labdedlpacarded, and are In at respects in <br />,:nor eondFm for transport according to applicable interna8onaland national gwerrintental regulations. If export shipment and I am this Primary <br />E)porter,. I oo* that the cardenN of the corrergmne, i': <br />,rm to the terms of the allached EPA Adinowledgment of Consent. <br />I cerl9y that the waste minimh�on statement Identlflr,oi it <br />CFR 262:27(a) ,l am a large quantity gen r) or (b) (If I am a small quan* generator) is true. <br />Ooneratorteit0hror's Pnrded/Typed N <br />Signetwi Month Day Year <br />16. International Shq>.rrerits ❑ Imporlto U.S. <br />❑ Feat from U.S. Port of eniylmdt <br />f. <br />z <br />Taansportersignature (for e(pprtsonly): <br />Dai Ie" U.S. , <br />n <br />W <br />t7.1 Adm of ofRecelptofMaterlals <br />T r 1 Pr mrypatl tv _ <br />�1. li�lio <br />Month Day Year <br />I ,, •� r'_ 1t �i I It'd I <br />18. Discrepancy <br />f188. Discrepancy Indicstian Space ❑ Quently IJ Type <br />t <br />I 18b. Alternate Facility (or Generator) <br />Facilitys Phone: <br />180. Signature of Alternate Facility (of Genera) <br />:18; Hazardous Waste Report Manage nt Method Codes W,, 'odes for hazardous wade treatmard, A <br />2. <br />1 <br />{I 20. Designate Facility Daer or Operator: Unification of i sceip I a malerlale covered by Bre <br />4 Pd e <br />i <br />f� EPA Form 870 22 (Ray. 3-05) rPrevious ei are oill:t* <br />1 <br />: <br />i <br />❑ Residue ❑ Partial R.*kn ❑ Full R " <br />Manifest Reference Number: <br />U.S. EPA ID Number <br />Month Day Year <br />and recycling sys6ams) <br />4. <br />',est except as rimed In sern lea _ <br />(,,r` DESIGNATED FACILITY TO GENERATOR <br />