Laserfiche WebLink
Ih <br /> Please orint or type. Form designed for use on elite 12• itch writer. Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121 , Generator ID Number 22, Page 23. Manifest Tracking Number <br /> (Continuation Sheet) CARM0235200 2 - of 2 010788708FLE <br /> 24, Generator's Name <br /> CVS #9261 <br /> 25, Transporter Company Name U.S. EPA ID Number <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 WtArol. <br /> 5. UN1993, Waste Flammable liquids , n . or s . 1 DF 00100 P 214 D0011 LI002 <br /> ( Alcohols , Acetone ) , 39 PGrII , ERG# 128 <br /> 6 . UN2811 , Waste Toxic solids , organic , n . o . s . 1 DF 00053 P 311 D007 D010 <br /> ( Chromium , Selenium ) , 6. 1 , PG II , ERG# 154 <br /> f <br /> O <br /> W <br /> Uj <br /> z <br /> j <br /> t <br /> 32, Special Handling Instructions and Additional Information 5. 100198 ( Flameable Liquids ) 6. 103446 ( CA Solid Pharmaceuticals ) <br /> 33, Transporter Acknowledgment of Receipt of Materials <br /> F Printed/Typed Name Signature Month Day Year <br /> i2 <br /> O <br /> CL <br /> Z 34, Transporter . Acknowledgmentof Recei t of Materials <br /> PdntedfTyped Name Signature Month Day Year <br /> t- <br /> 35, Discrepancy <br /> J <br /> V <br /> laL <br /> G <br /> Q36. Hazard us aste Re rt Management Method Code (i.e. es fjr hazardous waste treatment, disposal, and recycling systems) <br /> Z <br /> N <br /> w <br /> 0 <br /> EPA Form 8700.22A (Rev. 3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br /> 8700-22a 12Y3 CAL20090641 S8866 040973782 M PDi10917 SD110917 <br />