Laserfiche WebLink
,... ,,, I, IrurryPe . � Tpern' � r7--T �_ir <br /> UNIFORM H M�f1 7 8� L '' <br /> WASTE fNAZARDOUS 1 Gene ator ID Number Pr ppe o <br /> ResP01s <br /> ANIFEST �L 2. Page <br /> or 3. Emergency ,T� marling �dressl <br /> 5. Generator's Name and Mailing AdGress 1 � -'L 81 f different than <br /> Generators Sire Addres-` (I — <br /> r�r@Ct& M Strj ng $ Coati <br /> 321 E � �teet Ste F 8 RppppT06'la <br /> LI CA <br /> Generators Phone: er �. w <br /> 6. Transporter 7 U 5. EPA ID Numb v <br /> Company Name <br /> U.S- EPA ID Number <br /> � V <br /> 7. Transporter 2 Company nn eCal %2SPOrt ins. /DBA ACTorniro <br /> y Cf U Iu U.S. EPA ID Number 100 <br /> 8. Designated Fao6ty Name and SileAd - M <br /> LIS Eccg <br /> PO Box 5 �8%43da , Inc — <br /> Beetty (N1/ 85, 11 Miles S Beatty 13 Waste Codes <br /> Facility's Phone: 3 12. Unit <br /> 1t . Total WUVoi ,..,,,nom <br /> 9a. 9b. U.S. DOT Description (including Proper Shipping Name0qi <br /> , Containers Qual 1 g1 <br /> HM and Packing Group (if any)) , Hazard ClClass. ID Number.NANo Type <br /> P p��T D0081 <br /> R1 AFI <br /> 0 1 . y ist <br /> Q, 3077, Hazardous lll'asie. Solid, N . O. S. (Lead, <br /> Chromium) . 9 , PGE9 (D008) ) n <br /> W <br /> W 2. OU <br /> fin <br /> - C( <br /> 3. 41 <br /> tit <br /> - - n <br /> 4. 31 <br /> j r <br /> 14 . Special Handling Instructions and Additional Information{ MIr11b8r 41447? Doolmt� lit y i <br /> 7 X771 ' tTlQlaFt303r139Z7 PK . <br /> LL <br /> G packaged, <br /> /+ "' `- ro er shipping name , and are classified , p 9 <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION : I hereby declare that the contents of this consignment are fully and accurately described above by the pulations. If export shipment and I am the Pr maty <br /> marked and labeled/placarded, and are in all respects in proper condition for transport accordingto applicable intemationaland national govern ant reg <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. neralor is We . <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am"a small gyanhty ) Month Day year <br /> � Signature J � <br /> Generator's/OIs Ped <br /> 16. International Shipments ❑ Export from U .S. Port of enlrylexit <br /> ❑ Import to U.S. Date leavirrI <br /> H <br /> Transporter signature (for exports only) : I <br /> W 17. Transporter entofjIRII <br /> als Month Day liar <br /> Signature <br /> F Transporter,J.BdlTypedNa �e� �� ( <br /> a ` I ✓ r Slgnalure Mo h D ear <br /> Z Transporter 2Pdnte yped ame� <br /> r- <br /> 16. Discrepancy <br /> 16a. Discrepancy Indication Space Quanbly� � a <br /> ❑ Type ❑ Residue ❑ Partial Rejection Full Re ,e:6: <br /> 1 I i Manilesl Reference Number. <br /> US EPA ID Number <br /> lab Allem ataFeclUl o Generator) _ _ «... . �.. _. " <br /> J <br /> U <br /> LL Facility'e Phone : 1t„ a Day \Oat <br /> O 18c Slgnalure of Alternate Facility (or Genorabr) <br /> W <br /> III <br /> = of I Management Method Codes (Lo , codes for hazardous waste treatment, disposal , and recycling systems) <br /> 14 <br /> 0 19 hlazardeus Waste Rop 3, <br /> 2 . <br />