Laserfiche WebLink
Please print or type.(Form designed for use on elite(12-pitc),.ypewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> U.S.EPA ID Number <br /> 25. Transporter Company Name i <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> i <br /> _ I <br /> Z <br /> w <br /> ..f�� i ?s;i�'i`t '!'Si.Y F� 'i;3�.�.ti.t. r'�.�•'k151� r%.,. .. :N.�t;.tl i.�. ,. �- __....�. _ _._. <br /> 32.Special Handling Instructions and Additional Information . <br /> ;.I 5401 <br /> .i.1 At <br /> 33.,Transporter Acmowledgmem of Receipt of.Materials ^` Month Day Year <br /> LU Printed/Typed Name Slgft> ure <br /> F I <br /> Q <br /> CL <br /> CO 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed'fyped Name Signature Month Day Year <br /> 35.Discrepancy <br /> F <br /> LLJU <br /> C <br /> 0 <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> c7 <br /> h <br /> w <br /> O q <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL <br />