Laserfiche WebLink
Please p4nt or Form designed for use an elite 12• itch hter Form ApRroved.OMB No 20%a39 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121 Geierator ID Number 22�Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24 Generator's Name <br /> �r r� <br /> U.S.EPA ID Number <br /> 25 Transporter Company Name � � ! fr� 1 <br /> 26 Transporter Company Name �! ` U.S EPAIDNumber w <br /> a I 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)) <br /> No Type � Quantity WI./Vol- <br /> t <br /> o I <br /> z <br /> `" f <br /> t . <br /> 32.Speoial Handling Instructions and Additional Information <br /> 33.Transporter Ark ment of Receot of Materials <br /> Lu Pnnted,TypedName On yea, <br /> rY <br /> a <br /> ? 34.Transporter r..: Acknowledgment of Receipt of Materials <br /> PrintedlTyped Name Sqirrre Mwth Day ys <br /> H <br /> 35 Discrepancy <br /> U <br /> LL <br /> O <br /> a36 Hazardous Waste Report Management Method Codes I..e.codes for hazardous waste treatment.disposal and recycling systems,, <br /> z <br /> 0 <br /> cn <br /> ur <br /> G <br /> EPA Form 8700-22A;Rev.3-05) Previous editions are obsolete DESIGNATED FACILITY TO GENERATOR <br />