Laserfiche WebLink
Please print or typo, Form designed for use on elite 12 Itch ewritec Form Approved. OMD No. 2050.0039 <br />UNIFORM HAZARDOUS WASTE MANIFEST 2i. Gonoratbr ID Numbor 22. Page 23. ManlleslTracking Number <br />(Continuation Shoot) <br />24. Generators Name <br />Gulter Gould Medical Foudatloattucktull Medltsal Plats <br />25. Transporter. Company Name U.S. EPA ID Number <br />26. Transporter. Company Name U.S. EPA ID Number <br />27a, 27b, U.S. DOT Description (Including Proper Shipping Name, flazard Class, 10 Number, 2B. Containers 2g. Total 30. Unit <br />HM and Packing Group (II any) Ouant' 31• Waslo Codes <br />No. Type dy WtNol. <br />Z'J 1037, V1�1s1 � Gtllyl thlalde � to <br />U <br />331 <br />DF P <br />0 <br />w <br />Z <br />w <br />32 $pe ial)IandlingInstructions and Additional Information <br />aS �t�Ul3! E_�;c3#115 <br />33. Trans orter_Acknowled ment of Recel t of Matedals <br />LuPrinled/ryped Name Signature Month Day Year <br />O <br />IL <br />z 34. Transporter. Acknowledgment of Receipt of Materials <br />Pdnled/ryped Name Signature Month Day Year <br />} 35. Discrepancy <br />J <br />Q <br />W <br />D <br />a36. Hazallouss Waste Report Management Method Codes (I.e., codes for hazardous waste treatment, disposal and recycling systems) <br />w <br />0 <br />EPA Form 8700.22A (nev. 3-05) Previous editions are obsolete. <br />TRANSPORTER'S COPY <br />