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Please print or type. (Form designed for use on elite (12 -Ditch) tvoewriter 1
<br />EPA Form 87M22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)
<br />UNIFORM HAZARDOUS WASTE MANIFEST
<br />(Continuation Sheet)
<br />• ••
<br />21. Generator ID Number
<br />CA2890090002
<br />22. Page
<br />2
<br />rvim ryryi vveu. vmD rvv. [vDV-UVJy
<br />23, Manifest Trackin Number
<br />045870461 JJK
<br />24. Generat&s Name 7wence I ripfrinnFe , Vomit L3oormory Gqe 300 o
<br />P.O. Elox SM / L-786
<br />Lrrermore CA 94551
<br />25, Transporter Company Namo 17"i" U.S. EPA ID Number
<br />26. Transporter Company NameU.S. EPA ID Number
<br />ENVIRONMENTAL HEALTI
<br />27a.
<br />27b.U.S.DOT Desa h•on (including Proper Shipping Name, Hazard Class, ID Number,
<br />and Padang Group (if any))
<br />28': Containers
<br />29. Total
<br />Quantity
<br />30. UnitHM
<br />WWoI.
<br />31. Waste Codes
<br />No.
<br />Type
<br />5. UN3089, Waste, Metal powders, flammable, n.o.s., 4.1, 11 (Lab
<br />pack) [ERG 170] (DOP0117-1)
<br />1
<br />DF
<br />12
<br />P
<br />181
<br />0006
<br />8. RO, UN3508, Waste, Mercury contained in manufactured
<br />articies, 8 (8 [ERG 172] (DOP0071-1A)
<br />1
<br />DF
<br />13
<br />181.1)
<br />Woos
<br />7. UN1759, Corrosive solids, n.o.s., 8,11 (Lab pack) [ERG 154]
<br />(DOP0114-1)
<br />1
<br />DF
<br />5
<br />P
<br />331
<br />w
<br />°
<br />X
<br />8. UN2922, Waste, Corrosive liquids, toxic, n.o.s., 9 (8.1), II (Lab
<br />pack) [ERG 154] (DOP0114-1)
<br />1
<br />DF
<br />6
<br />P
<br />791
<br />D002
<br />w
<br />9. UN3288, Waste, Corrosive liquid, basic, inorganic, n.o.s., 8, II
<br />(Lab pack) [ERG 154] (00P01 14-1)1
<br />DF
<br />1i
<br />P
<br />222
<br />D002
<br />10. NA3077, Hazardous waste, solid, n.o.s. (D007, 0008), 9,111
<br />[ERG 1711 (DOP0038-1)
<br />i
<br />Did
<br />107
<br />P
<br />131
<br />D006
<br />11. NA3077, Hazardous waste, solid, n.o.s. (0007, D010), 9,111
<br />(ERG 171] (DOP0038-1)
<br />1
<br />DF
<br />8
<br />P
<br />182
<br />Doo?
<br />12. NA3077, Hazardous waste, solid, n.o.s. (0008), 9,111 (ERG 1711
<br />(DOP0038-1)
<br />1
<br />DF
<br />25
<br />P
<br />1s2
<br />0008
<br />13. NA3077, Hazardous waste, solid, n.o.s. (DO08), 9, III [ERG 171]
<br />(DOP0105-1)
<br />1
<br />DF
<br />39
<br />P
<br />182
<br />Doos
<br />14. NA3077, Hazardouswaste, solid, n.o.s. (D008), 9, Ili [ERG 171]
<br />(DOP00m-1)
<br />5
<br />DN
<br />589
<br />P
<br />281
<br />DD08
<br />32. al Handling Instructions and Additional Information
<br />33. Transporter Acknowledgment of Receipt of Materials
<br />Printed/Typed Name Signature Month Day Year
<br />c>:
<br />0,
<br />y
<br />34. Tra Admowtedgment of Recelpt of Matedals
<br />Pdnted/Typed Name Signature Month Day Year
<br />35. Disaepancy
<br />U
<br />LL
<br />O
<br />a36.
<br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)
<br />C7
<br />rn
<br />LU
<br />O
<br />EPA Form 87M22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)
<br />
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