Laserfiche WebLink
Please print or tvpe, Form designed for use on elite i 12 itch ewriter. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21•Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) CAL0003MMI � s <br /> 24.Generator's Name <br /> $ <br /> P.WTNC,! SAM <br /> 25. Transporter �� Company Name U.S.EPA ID N0Mber-STM <br /> 26. Transporter Li CompanyName �, <br /> Y, t' <br /> 27a. 27b.U.S.DOT Desaiption(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 31.Waste Codes <br /> 0 <br /> W <br /> Z <br /> w <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Admowled ment of Recei t of Materials <br /> Lu Printedfryped Name''"- Signature� ..... .._ 9 Mond Day Year <br /> IL <br /> 0Anqq2 Kfth 1 21 21 L17 <br /> Z 34.Trans iter ±1R 't d:.Mateijale - <br /> Printedfryped Namd Signature on ayY, r <br /> 35.Discrepancy NIA 4 <br /> 7 <br /> C? <br /> G <br /> LU <br /> a 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> N <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />