Laserfiche WebLink
Please�rint or tyW. Form designed for use on elite 02-nitrhl typwrijar. <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 a rator ID ber 22. age 23.Ma 'est Tracking Form A roved.OMB No.2050 0039 <br /> (Continuation Sheet) r <br /> 24.Generator's Name <br /> 25.Transporter Company Name �! _ 1 U.S.EPA ID Number <br /> �i s 03�ss s <br /> 26. Transporter_ Company Name U. . AID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard pass,ID Number, <br /> HM and Packing Group(if any)) 28.Containers 29.Total 30.Unit <br /> No, Type Quantity WtNol. 31.Waste Codes <br /> O <br /> w <br /> z <br /> w <br /> 0 <br /> J <br /> 32.Special Handling Instructions and Additional Information <br /> IX33.Trans rte(-' Acknowledgment of Receiptof Materials <br /> LLJPr nted Typed , Signature <br /> 0 r� . <br /> Month Day Year/ <br /> a J <br /> Z A 34.Trans iter Acknowled ment of Receipt t of Ma als <br /> Printec:yped Name ignature <br /> Month Day Year <br /> 35.Discrepancy f }f <br /> U <br /> U< <br /> G <br /> W <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> C7 <br /> rq <br /> w <br /> O <br /> EPA Form 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />