Laserfiche WebLink
Please Print or Form designed for use on elite 12 Itch writer Form Approved.OMB No 2050-0039- <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator 10 Number 22.Page 23 Ma�l6et Tracking NWiber <br /> Continuation Sheet e ! f`t r <br /> 1 ) f} Cali <br /> e ,5 ` ' 1 ?IBJ <br /> 24.Generators NNa�me�,.,p <br /> 25. Transporter Company Name ,r V� U.S.EPA D}`Number <br /> 26. Trans 7 U:S.�Number g <br /> porter Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 26.Containers <br /> HM and Pacloing Group(d any)) 29.Total 30.Unit 31Waste Codes <br /> No. Type Duanfiry Wt.Nol. <br /> C <br /> C <br /> W <br /> C7 <br /> 32.Special Handling Instructions and Additional Information <br /> L33Tram r AcMowl ment ofR ofMaterals <br /> Hd/fyped NameMonth Day. Yeara �, damtns rter Ack mentof i of terufs <br /> PdnteNTyped Name - nature Doth y ear <br /> 35.Discrepancy. <br /> J <br /> U <br /> D <br /> W <br /> z36.Hazardous Waste Report Management Methal Codes i.e.,codes for hazardous waste treatment, <br /> ( disposal,and recycling systems) <br /> N <br /> W <br /> O <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />