Laserfiche WebLink
02/27/2004 FRI 13:10 FAX 13232689672 DK ENVIRONMENTAL <br />_ .. __ ..-- —4tQ Q3_ ._- <br />EPA Form 0700-22A (Rex 9-90) PrQvious adilloni are cCSolele. <br />TSDF COPY <br />UNIFORM FIAZARi)O11$ <br />21 Generators US EPA ID No. Manifest Document Na <br />22. Page <br />Infdrmation In the shaded <br />WASTE MANIFESTj� <br />(Continuation Sheet) <br />"T,o �- �. <br />iv -• <br />areas is not required by Federal <br />/ <br />�� <br />law. <br />23. Generator's Name jr j <br />L State Manifest Document Number <br />91ate.Generators ID <br />24. Transporter Company Name 25. US EPA ID Number <br />N_ State Transporters 10 <br />O. Transporters Phone, <br />26. TransporterCompany Name 27. US EPA ID Number <br />P. State <br />P. StateTransporter's ID <br />Phone . <br />28. US <br />DOl Description (Including Proper Shipping Name, Hazard Class, and 10 Number) <br />29. Containers <br />30. <br />Total <br />31. <br />Unit <br />Waste No. <br />HM <br />No. <br />Type <br />Quantity <br />WvVol <br />... <br />a <br />QrS�,��4�;3cis <br />b. <br />+.J fit✓ !. <br />3 <br />�.P.✓ <br />y� <br />J. / <br />iJ U K' <br />o <br />C. <br />. <br />.... <br />G <br />E <br />d. <br />E <br />A <br />• <br />e. <br />T <br />O <br />t. <br />n.- <br />F <br />S..Addib,onal eDeserlp bels tor -Materials Listed Above - <br />T. Handling Codes for Wastes Listed Above <br />J <br />C✓ <br />t' <br />32. Special Handling Instructions and Additional Informatlon <br />A) rg+ 4: I>ry�ic <br />1'40E.' <br />.47 <br />, <br />T <br />R <br />33. Transporter _ Acknowledgement of Receipt of Materiats <br />Dale <br />A <br />N <br />Printed/'typed Name <br />Signature. <br />Month Day Year <br />9 <br />P <br />o <br />R <br />34. Transpot ter ,— Acknowledgement of Recelpt of Materials <br />Dale <br />T <br />E <br />Printed/Typed NameSig <br />nature <br />Vonth Day Year <br />R <br />F <br />c <br />35. Discrepancy Indication Space <br />Q' <br />L <br />r <br />EPA Form 0700-22A (Rex 9-90) PrQvious adilloni are cCSolele. <br />TSDF COPY <br />