Laserfiche WebLink
Please print or Form designed for use on elite 024tchForm Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1 21 Generator ID Number 22.P 23.Manifest Tracking Number <br /> (Continuation Sheet) Z 1 <br /> 24.Generators Name <br /> 25 Transporter-3 Company Name U S.EPA ID Number <br /> 26 Transporter- --- Company Name U.S.EPA ID Number <br /> �y <br /> ��J v <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)) <br /> No. Type Quantity WtNol. <br /> i <br /> O <br /> z <br /> W <br /> U' <br /> t <br /> 1 <br /> ) <br /> 32,Special Handling Instructions and Additional Information <br /> Cr 33.Transporter t of R ' of Materials <br /> H PrinterUT .4me S� Signature a� <br /> `Mo <br /> a <br /> Z 34 T ment of Receo of MaWhals <br /> PrinWIT Name Signature Year <br /> 2zi <br /> F— e, <br /> 35.Discrepancy <br /> J <br /> U <br /> a <br /> c <br /> W <br /> Q 36 Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> S2 <br /> Uj <br /> W <br /> EPA Form 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />