Laserfiche WebLink
Form ADproved.OMB Na.2050-0039 <br /> Please Tint or Form des nod for use on Nile 12 ter. �,Pam z3,YanlMat7nck6q NrmMr <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21,Ganeralor ID Num ar <br /> (Coranuadon sheell CATOODS17514 411256/65FLE <br /> 24 Ciereratoes Nam r <br /> YaiQTAO TiYY1Y,�At 5/10i0Af1IW40LQTrGRCM101 P QOUF <br /> U.S.EPAID Number <br /> 25. Tmnsww Cmgany Name y <br /> lug., lices DS EPW <br /> 26.TransporterTransporterf,dnparry Name /�� <br /> 1cc� rfGD dJ�d l�J�l <br /> 27,. 27b.U.S.DOT DesaiPbon(induding Pmper lSf org Name,Hazard Class,ID Wmber, 28,Containers 29 TOW 30.Unit 31.viaste Codes <br /> IIA and Packing Oroup(If arM)) No. Type OuanoP7 Wt.Nd. <br /> O <br /> TPOW <br /> Z <br /> W <br /> 69 <br /> R <br /> 7 <br /> OC 27 201 <br /> 32SpecW Hmdng lnsbudlans and AdMonalntmmation ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> 33.7 AdwMedwwd of Remol ofMdelals Signa e Month DaY ves <br /> w ftway*Name v{ <br /> rc <br /> 0 <br /> z34.7 dRexi OfMaW'* on ear <br /> rryped Name� 7-4e � <br /> 35.DscrWrily <br /> U <br /> LL <br /> M.Hazardous Waste Report Managemem Method Cades(.e.,miles fur harardaus rrasle eaahnent,dspmal,and rerycllrg systems) <br /> z <br /> S2 <br /> N <br /> W <br /> D <br /> EPA Form 8700-22A(Rev.3.05) Prevbusedldonsareobsolele. DESIGNATED FACILITY 70 DESTINATION STATE(IF REQUIRED) <br />