Laserfiche WebLink
ire6 print or type. Form designed for use on elite 12 itchtypewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARQOUS WASTE MANIFEST 21.Generator ID Number s „ 22.Page 23,Manifest Tracking Number <br /> (Continuation Sheet) S} A L-ir <br /> t 24.Generator's Name <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> 26.Transporter Company Name <br /> U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shlppirig Name;Hazard Class,ID Number, 2B.Containers 29:Total= 3A.Unit 31.waste"Codes <br /> HM and PackiogGfouup(if any)) k p( y y No. Type Quantity Wt./Vol,) +'y <br /> Pk <br /> V N1. yl�',�iC '"•� PS..:r S 14'r.E IJ t v! PAS, rn ��pjia <br /> rj <br /> K <br /> e <br /> O <br /> =f <br /> LU <br /> i^ - - .. -t( =} <br /> IlV2 o '1','- •.7,e_.'t <br /> -'j i ?:illi Irl ct� <br /> M op <br /> !'F::' r e: .,7 _f...J .., - (` •'—'15 -{ '-j.Zj_ <br /> : <br /> u <br /> 32.Special Handling Instru tions and Additional Information Oilr <br /> r �,�` ���• � � � •i �/� f..l �`t '1 fi gay !��`1 <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> LLJ Printed/Typed Name Signature Month Day Year <br /> O <br /> 0. <br /> Z 34.Transporter Acknowled ment of Receipt of Materials <br /> < Printedrryped Name Signature Month Day Year <br /> ix <br /> 35.Discrepancy <br /> f— <br /> J <br /> U <br /> tai <br /> W <br /> z .36.Hazard us Wast Report Management Method Qdt e;(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU <br /> EPA Form 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />