Laserfiche WebLink
Form Approved. OMB No. 2050-0039 GENERATOR ) UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. -operator ID Number __,.. <br />--- 7)1(-(,7)(_)' 7S V/-)1 <br />2,2.,,P,ag 23. Kani,fest Tracking Number <br />Generator's Namo <br /> ..,;/ A ----j <br />. . U.S. EPA ID Number <br />Transporter ) Company Name ////d i „..) „....-, i_.)/,- <br />1/4/ ) >! / (i'. <br />U.S. [PAID Number <br />Transporter Company Name <br />I <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 (II any)) No. Type Quantity Wt.Nol. <br />_ <br />Special Handling Instructions and Additional Information <br />..,„ Transperter_.) Acknowledgment of Receipt of Materials <br />1 TRANS PORTEF Printed/Typed Name 1 Signature Month Day Year <br />il.--- <br />lab ' lidi - 2vi 05 <br />Transporter Acknowledgment of Receipt of Materials <br />Printed/Typed Name Signature Month Day Year <br />I I I I DESIGNATED FACILITY I Discrepancy <br />Hazardous Waste Report Management Method Codes (in., codes for hazardous waste treatment, disposal, and recycling sys(ems) <br />I I I I <br />EPA Form 8700-22A (Rev. 12-17) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO s e-