Laserfiche WebLink
.., rC.,.._.r L.w..,,14 f— .fdn 119.eLdehl rurv-,ui Pf I <br />Farre AO m"& OMB No. 20,9H039 <br />EPA Form $700.22 (Rev N5f Previous edfions are UWaIeW I If r UNAM-D I"A( ury i o UE311NA110N STAM'(1F RE UIII,[:I)) <br />UNIFORM HAZARDOUS <br />1 Generator ID Wwdrer <br />L Paget Of <br />� <br />3. fmcryertry fiesp°rtm }?Ane <br />1800-535-5053 <br />4. t Tr Nurftber <br />010401558 FLE <br />WASTE MANIFEST <br />Intotrac <br />S. U&wjUWjNanseOMA g GS Minim Company LLC ,etteramrs 5M Addrwaf fddllwf ms <br />PO BOX 679 Golden Gilpin Mill, CO Hwy 119 <br />Blackhawrk, CO 80422 <br />akphwm k CO MM22 <br />Geneneces <br />rwq,,,,w NMV Us. EPA ID M &vbv <br />AET ENVIRONMENTAL, INC, COR 0 0 0 0 0 9 4 5 6 <br />I Ttanevwlarz No= U. EPAIONtertber <br />11(ft9no'ad FacelyNarne arer SbAddrdu CLEAN HARBORS ENVIRO SVS, INC.-1Cmba ll U.S ENIDfkanber <br />liar 3OUth Hlphway 71 <br />KIMBALL, NE 69145 <br />356 235-9205 N E p 9 8? 7 2 3 5 1 3 <br />f. a Phone <br />pa. <br />9b US COT Doscippon (rdt drop Ptaiur 5luppit g Narne, Naaard Gess D fknnher <br />10 l Ont m yrs <br />11 TOW <br />12 bo. <br />13. Wasle Cod" <br />No. <br />Typo <br />Hsl <br />sed Pucking Omup G any)) <br />Ouaelity <br />1A' AU <br />1 UNI 689, Waste, Sodium Cyanida Solid, 6. 1. I <br />o <br />x <br />9a <br />ot <br />LU <br />Z <br />2 <br />3 <br />fa. gra twivuebm aw Wftrid hz;;w a; CH1573663 t1(3p <br />15 GENERAT'OW&OFFEROR'S CERTIFICATION: I ftereby iedaro Mat the Cafd d pd1 gmdgrmenl em fupy and accumlely desdbed abma by the Rapersh�pmg Herne and are dasUfiad packaged <br />otaked and F.fholedfplar rded, mid am in all mspecls in Woperccnd;tan for tranuourtamaL" In upprsaW° Mstemaliard wW rratwW gummsnnlel reyetolims. If erpart shpnrnt end I art par Prrne7 <br />EerMer. I cedq IW Eto sanhmis of lis coa* a wril ambo m she lemts of±M altxhed EPAArkwaledgmrnt of Convent <br />I cenifylhal tho www m*witalw etateroem lderdllied in 40 CFR 25227(n) (p' are aUrge quanplr peaera" of (b) (If I am a UnM4oanft gerwator) Is Out. <br />awrarswco., h ry -,--j ° Month y year <br />k1 <br />J <br />1.1nrsm lio 'uweNa <br />E]71,limonb US. E> pal 4ctnf US. of anlrylexd: _ <br />Len orlw i tura b !! f: Dam wavy US_ <br />ul <br />17 Trarap nerkinotWodgnterlorRemocimabrinis <br />My <br />T ansrnur l yped ex <br />p� <br />N <br />'[+i1 <br />uap°ACr 2 FA0 WjlW Nnw R <br />ZTr <br />Is Orlaepa+cy <br />Ills. Diseepancy Irefiradan $parr ❑ cenentby ❑Type ❑ p..id,. ❑ pertlal fiejdaw ❑ Ful Rejeclkm <br />Manifest Referretce Murttlwr' <br />J <br />19b. Alternate Facility (a Ge,ctala) U.S EPAID Number <br />r..1 <br />d <br />� <br />fttcli aPliona: <br />1& . S gneluro °! ANemsta FxLry (°r G°nerabrl Row Qty Yrar <br />4 <br />x <br />19. Hazardous Waste Raml Management Uelnod Codas (i.w. code$ far heaardoua mstJe beabnent, disposal ord retypeg fyelr•rs) <br />7T <br />20. DMignatei F;WMI Owner n Opondor: Loffiie2tion of nmviPI ul Mzerdous matarlak rxiv xnd by pte ntaridesl etcefd e3 noted in Item lee . <br />nnw yped Norm Sgmlure Lwan Day Yenr <br />EPA Form $700.22 (Rev N5f Previous edfions are UWaIeW I If r UNAM-D I"A( ury i o UE311NA110N STAM'(1F RE UIII,[:I)) <br />