Laserfiche WebLink
Please print or type. Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> U.S.EPA ID Number <br /> 25. Transporter Company Name <br /> I A 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.Nol. <br /> 1 <br /> o <br /> w <br /> Z <br /> w <br /> I <br /> 32,Special Handling Instructions and Additional Information <br /> 14:5-5 <br /> W 33.Transporter Acknowledgment of Receipt of Materials <br /> H Printed/Typed Name Signature Month Day Year <br /> W, <br /> O <br /> a. <br /> z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed[Typed Name Signature Month Day Year <br /> H <br /> 35.Discrepancy <br /> L) <br /> w <br /> 0 <br /> LU <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C9 <br /> LU <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />