Laserfiche WebLink
Please print or type. Form desictried for use on elite 12 itch I rewriter.) 61170296412&002 SC PP91I 5/3012017 Form Approved.OMS No.:2050-0039 <br /> UNIFORM HAZARDOUS WASTE MAN112EST 21.GeneratnrlD Number 22 Page 23.MenHesl TracMng Number <br /> (Continuation Sheet) g g 3 6 0 0 5 9 4 2 01.0897223FLE <br /> 24.Generators Name " <br /> Kaiser Permanerft <br /> UL EPAID Number <br /> 25.Transparter Company Name A / /W&—:n <br /> r /--��w n A <br /> US.EPAID[Number 77+- G7 <br /> 2fi.Transporter Company Name <br /> 27a. 27b.U.S.DOT Desaipliolindudng Proper Shltiong Name,Heated Cleans,ID Number, 28.Containers 21.r Total 30.Unit 31.Waste Coder <br /> HM and Packing Gmup(ifairy)) No. Type Currey WIJVol. <br /> x 5.UNi95L WASTE MEO[ONE.LK)UID.MXIC.N.OS..(MER(:U 0009 141 331 <br /> 6:1.PG 111 0 0 i D IF 00005 P — <br /> 6.UN3266.WASiECORROSIYELIQUID.BASIC.INORGANIC. D002 551 <br /> x N.OS.,{SODIUM NYPOCNLORITEI,S.PG II 001 D F 00006 P <br /> T.N0K-RCRA HAZARDIGUS WASTE,LIQUIDS,(FORMALIN.Tll!SIJIE 311 <br /> 00i C F 00063 P <br /> 0 <br /> D�v <br /> SP19201 <br /> LH LTH <br /> PERMIT SFRVICFS <br /> 32.Special Handling Ins"otons and Additia7zl laceration <br /> S.CH538285 ERG#1511X10 <br /> 6.LCCRB EAG4154 1X5 <br /> 7.CH1218596 1X30 <br /> 33.Tran Aclossaiedgmerit of Rereicbol Materials -- <br /> PiintedRyped Name — -— Slgrelure Month Day Year <br /> a <br /> ��- Z _--..._.. 1 6 1 i611 <br /> = 34.Tmns der AcknoM memofRe iptof Materials <br /> Printecirryped Name :gret -- I Dried ay eer <br /> 35.Discrepancy <br /> J <br /> U <br /> 1,- <br /> IM O <br /> 4 36.Harardous Waste Report Managemem Method Codes(i.e.,codes for hazardous waste treaanent,dis{usal,and recydal systems) -- <br /> ID 5 U040 6.M040 1 7 1104,1 1 L <br /> W <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED) <br /> Clean Harbors hasthe appropriate permits fear and will accept the waste the Ijenefator is shipping. <br />