Laserfiche WebLink
Please p4nt or Form designed for use an elite 12• itch rites Form ApRroved.OMB No 2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121 Geierator ID Number 22�Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24 Generator's Name <br /> �r r� <br /> 25 Transporter_� CampanyName <br /> U.S.EPA ID Number <br /> 26 Transposer Company Name U.S EPA IDNumbef w <br /> a I 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)) <br /> No Type � Quantity Wt.NoL <br /> t <br /> I <br /> z <br /> `" f <br /> t . <br /> 32.Speoial Handling Instructions and Additional Infomlation <br /> 33.Transposer . Ack ment of Receot of Materials <br /> Lu Pnnted,TypedName g, 7y� kms. On yea, <br /> rY <br /> a <br /> ? 34.Transporter r..: Acknowledgment of Receipt of Materials <br /> PrintedlTyped Name Sqirrre y <br /> H <br /> 35 Discrepancy <br /> U <br /> LL <br /> O <br /> a36 Hazardous Waste Report Management Method Codes I..e.codes for hazardous waste treatment.disposal and recycling systems,, <br /> z <br /> C7 ' <br /> cn <br /> ur <br /> G <br /> EPA Form 8700-22A:Rev.3-05) Previous editions are obsolete DESIGNATED FACILITY TO GENERATOR <br />