Laserfiche WebLink
Please orint or tvoe. (Form designed for use on elite (12-nitnh) tvnpwritpr 1 <br />P— &---i OAAA Aln on CA Anon <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY [Cl UtS I INAI IUN 61 AI t (it- r<tuulneu) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. Generat r ID Number <br />L Q S� <br />22. Pae <br />23. Menffest Tracking bar <br />o Sr <br />24. Generator's Name e <br />J S <br />25. Transporter _Capany Name U.S. EPIDlumper� Ay 4w&-A� Stc <br />26. Transporter Company Name U.S. EPA ID Number <br />273. <br />HM <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />26. Containers <br />29. Total <br />Quantity <br />30, Unit <br />Wt Nol. <br />31, Waste Codes <br />No. <br />Type <br />a <br />0 <br />w <br />z <br />w <br />c� <br />32. Special Handling Instructions and Additional Information <br />cr_ <br />Uj <br />Ce <br />0 <br />33. Trans iter Acknowledgment of Receipt of Materials <br />Prime yped Name �� Signa Month Day Year <br />Z c © l <br />CL <br />34. Transporter Acknowledgment of Receipt of Materials <br />Pnnted(Typed Name Signature Month Day Year <br />U <br />Q <br />LL <br />Uj <br />35. Discrepancy <br />Q36. <br />z <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />N <br />w <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY [Cl UtS I INAI IUN 61 AI t (it- r<tuulneu) <br />