Laserfiche WebLink
sP~~os3o ~C-~-S[~C-R7c~~5- <br />Emergency Contact Telephone Number <br />~- a t - 6a <br />EPA Fortn 8700-22 Rev. 9-9 III IIIIII'll I <br />Pr <br />Fo sgs <br /> UNIFORM HAZARDOUS 1. Generators U EPA ID No. <br />' Manifest <br />nt <br />N . 2. Page 1 Informatl Rt s aded areas is <br /> <br />i <br />I <br /> WASTE MANIFEST: . .(~ <br />.Q (~.` O <br />~fl pf not requ <br />F <br /> ,E/yyy1...oer~, Na.~e a^nyy.Mai pdOre s r <br />~ o~ `~ Hest'D'oTirrie Y li' e`r <br /> %J tf1B6 ~2powt <br />S~` ~7.~urf Co $oZ,o3 ~ '~I! <br />l <br />fi'"' " <br /> " 141in9~als <br />eo gy <br />an{ <br /> 4. Generators Phone(~'~ ) ~ - 3 <br /> 5. Transponer 1 Company Name 6. US EPA ID Number C~S`ta eClTranapprter I <br /> <br /> 7, Transponer 2 Company Name ~ 8. US EPA ID Number E, rans`part <br /> gran port s Fhon <br /> 9. es' a Facility N m nd e A dress 10. US PA ID Number <br />ll~v ~6~or one ~a,~pt 7 <br />1v~- ~/f-v <br />Mn~. G S a nq s <br /> , <br />~ <br />T- So <br />MilGS 6~`-ST <br />L' 7inl~s ~°~ 0 ~o is ~; ~fl <br /> , <br />~ ~n <br /> <br /> 11. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. 14. <br /> <br />HM <br />No. Total Unit <br />T pe Ouanti WWOI Wes e,. o. <br /> a. S ~ <br />OPII~'lh~ 1c0 S <br /> l <br />UNZSI~ ~C <br />Q <br /> y o~ <br />G b. <br />E <br />N <br />E <br />R <br />A c, <br />T <br />O <br />R <br /> d. <br /> A ili'V le ~~lade iS Ha r a Ste <br /> p~ s , <br /> O ~ <br /> 15. $/eytial FWntlling Instructions and A~onal Intormatbn r-~'ID 4 <br />i <br />J/ <br />J <br />7 <br />S,~,.r <br />.,f <br />. <br />/ <br />( <br />~• <br />V 1"`"/ I G V t - <br />~-ygvllLS l1daT Mf~J¢ <br /> r <br />7 <br />T <br />D <br />7 <br />V <br />T <br />~ <br />t <br />~ <br />~f ~ <br />9 <br /> " <br />~-pia-a~i-~ °~~- I ~ ~ 15 ro~Su.r~s <br />S~ <br />4M <br />~ <br /> ~ <br /> 16. GENERATOR'S CERTIFICATION: I hereby tleclara That me contents of Ni signment are lully end accurately described above by proper shipping name and ra classified, <br /> pecked, markeQ end labeled, antl are in all respects in proper mndiaon for trenspon by highway eccortling to applicable intemationel and national governmental regulations. <br /> II I am a large quantity generator, I ceniy that I have a program in place to retluca the volume and toxicity of waste gene reted to the degree I have determined to be economically <br /> precbwble end Nat I have aelecYetl the practicable method of treatment, storage, or disposal currently available to me which minim¢ed the present and future threat to human health <br /> and the environment, OR, if 1 em a small quantity genamror, I have matle a good Leith effort to minim' y waste generation and salad the best waste management method that is <br /> available to me and met I can eflom. , <br /> Pnnled/fypetl Name Signature Month Day Year <br /> Evtca s. Crcr~ as a ~- ft~r 1'! D'a 9'S <br />R 17. Transporter 1 Aclmowledgement o eceip[ of Maerals . ~ ~ ~~ <br />A Pnnled/Typed Nama Signet a <br />. Monts Day Year <br />P ~ a n~ ~ <br />H 1B. Transporter 2 Acknowletlgement o1 Receipt of Materials <br />T <br />E Printed/Typed Name Signature Month Day Year <br />R . <br />19. Discrepancy Intlicaaen Space ~t' ~~~ ~/s ~1~~j[,v ~T ,SI ~ ~OI(~ I (.~' ~~ ~(~ ~ ~ ~ (/Jt~fj (7~]•JUJ(~j ~i~ yy/.~ <br />A <br />C <br />I <br />~ 20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manilest except as noted in Item 19. <br />T <br />Y <br />Pr~nte ypetl Name to a Month Day Year <br />~T= rv~i ~ t I ~'Vl ~~ ~ Inc ~ ,t'S ;) ~ ~ ,.~ ~/y~, ~f--r h ~, i I ~ U ~}tea :~ <br />ORIGINAL -RETURN TO <br />