Laserfiche WebLink
Please on or (Form designed for use on elite(12-pitch)Imewriter.) Form proved.OMB No.205D-OM <br /> UNIFORM HAZARDOUS WASTE MANIFEST ^21 Generator ID Number J 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) A ��� <br /> 24.Generator's Name <br /> 25. Trans Com ray me (� _ J U.S.EPA ID Number <br /> t G/ ,✓� ll <br /> v <br /> 26. Transporter Company Name IJ U.S EPA ID Number <br /> 27a. M.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group('d any)) No. Type Quantity WUVoI. 31.Waste Codes <br /> O <br /> W <br /> Z <br /> W <br /> 32.Special Handling Instructions and Additional Information <br /> 33,Transporter Acknowledgment of Receipt of Materials _ <br /> F PrintedName / I Signature Month Day Ye <br /> a ��J i t/1i1' C, ,1W11 <br /> Z 34.Transporter Acknowledgment of Receipt of Materials y <br /> Prnted/Typed Name Slgnalum= Month Day Year <br /> 35.Discrepancy <br /> v <br /> LL <br /> 0 <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> t7 I I I I <br /> H <br /> W <br /> C3 I I I <br /> EPA Form 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />