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�7 <br />Please print or type. (Form designed for use on elitt itch) typewriter.) <br />Form Approved. OMB No. 2050-0039. <br />Style CF 1 R LAKLISI, SMO 8 OMI -5808 EPA Form 8700-nA (neV 9-88) Previous editions are obsolete. <br />GENERATOR COPY <br />UNIFORM HAZARDOUS <br />21. Generators US EPA ID No. Manifest Document No, <br />22. Page <br />Information in the shaded <br />WASTE MANIFEST <br />areas is not required by Federal <br />(Continuation Sheet) <br />law. <br />23. Generator's Name <br />L. State Manifest Document Number <br />1-469"1!4 <br />- - <br />M. State Generators ID <br />M. <br />24. Transporter Company Name 25. US EPA ID Number <br />N. State Transporter's ID <br />O. Transporter's Phone <br />26. Transporter Company Name 27. US EPA ID Number <br />P. State Transporters ID <br />O. Transporter's Phone <br />29. Containers <br />30. <br />31. <br />R. <br />28. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />Total <br />Unit <br />Waste No. <br />atn <br />No. Type <br />Quantity <br />WWol <br />a. <br />... ,. ..,. <br />b. <br />- <br />C. <br />G <br />d <br />E <br />N <br />E <br />r- T. <br />R <br />A <br />e. <br />T <br />O <br />R <br />It <br />g, <br />h. <br />I. <br />S. Additional Descriptions for Materials Listed Above <br />T. Handling Codes for Wastes Listed Above <br />_res;41: a":[ 1. - j .. atli• 'i }480.1 s` ., <br />I t J] Y + n !9Fls 3 _ ) }" r3rJ <br />r <br />32. Spgcial Hand ling,Instructions and Additigna.t In(grmabgq„ <br />T <br />33. Transporter Acknowledgement of Receipt of Materials <br />Date <br />R <br />Printed(fyped Name <br />Signature <br />Month Day Year <br />N <br />S <br />o <br />34. Transporter _ Acknowledgement of Receipt of Materials <br />Date <br />T <br />PrintedlTyped Name <br />Signature <br />Month Day Year <br />E <br />R <br />F <br />35. Discrepancy Indication Space <br />A <br />C <br />L <br />T <br />Y <br />Style CF 1 R LAKLISI, SMO 8 OMI -5808 EPA Form 8700-nA (neV 9-88) Previous editions are obsolete. <br />GENERATOR COPY <br />