Laserfiche WebLink
Please print or two. Form.designed for use on elite 92- Itctt t ewriter. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generat.rIDN,imber 22.Page 23.Manifest Traotting Number <br /> (Continuation Sheet) �' E3 �,!• .�C" <br /> 24.Generator's Name <br /> Q <br /> t <br /> 25. Transporter_ Company NameU,S,EPA ID Number <br /> U.S,EPA ID Number <br /> 26, Transporter Company Name <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)) No. Type Quantity Wt.Noh <br /> O <br /> W <br /> Z <br /> LU <br /> C7 <br /> 32.Special Handling Instructions and Additional Information <br /> 33,Trans for AcknoWled went of Recei I ofetddets <br /> Priv atinyped Name Signature Month Day Year <br /> 0 tl�' U�� �4� ���/" <br /> z 34.T oder , AcknowledgmentofRaasi tofMaterials <br /> Printed/Typed Name S11gnaure Monlfi Day Year <br /> F— <br /> 35.Discrepancy <br /> F <br /> J <br /> C? <br /> LU4 <br /> al <br /> a <br /> 36,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ca <br /> Lw <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />