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Please print or type. Form designed for use on elite 12- itch writer. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page z3.Manifest 7rocking Number <br /> (Continuation Sheet) CAR000231712 2 of 2 012121047FLE <br /> 24.Generator's Name <br /> CVS #9830 <br /> U.S.EPA ID Number <br /> 25, Transporter Company Name <br /> 26. Transporter Company Name U.S.EPA ID Number <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 WtNol. <br /> X 5.UN3249, Waste Residue Last Contained, 1 CF 00001 P 311 P001 <br /> Medicine, solid, toxic, n. o. s. (Warfarin), <br /> 6. 1 PG II ERG#151 <br /> 6.Non RCRA hazardous waste, liquid (State 3 DF 00340 P 331 <br /> Regulated Water Based Consumer Products), <br /> O <br /> w <br /> z <br /> w <br /> O <br /> 32,Special Handling Instructions and Additional Information 5. 101079(Residue weight does not exceed. 0.0436 lbs) CNT:47 6. <br /> 102979.(State Regulated.,Liquids) <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> w Printedl7yped Name Signature C7 pqth Day Year <br /> O <br /> a <br /> Z 34.Transporter ment of Receipt of Materials <br /> Printed/Typed Name SignaWre 1 t 2bM Monthay Year <br /> 35.Discrepancy ENVIRONMENTAL_ HEAL! h <br /> a DEPARTMENT <br /> LL <br /> 0 <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> C7 `tet <br /> U) <br /> LU <br /> D <br /> EPA Form 8700-22A(Rev 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 8700-22a 12v3 CAL20090641 S40005857 041196797 M PD090818 0090818 <br />