Laserfiche WebLink
Please print or type. Form designed for use on elite 2-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121-Generator ID Number 22.Page 23.Manifest Tracking Number c <br /> (Continuation Sheet) 5+.+fy W 0Icty <br /> 24.Generator's Name <br /> 25. Transporter Company Name U.S.EPA ID umber <br /> 26. Transporter Company Name U.S.EPA ID Number <br /> C leap l Qr�o6 A�0393ZZLs� <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 Wt.Nol. <br /> O <br /> w <br /> z <br /> w <br /> O <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> w Pri d Name lure Month Year <br /> O 1/VA � I <br /> CL <br /> z 34.T r Acknowled m t of Receipt of Materials <br /> P' ted(T Name Eignature Month Day Year <br /> D <br /> 35. iscrepancy <br /> J <br /> U <br /> Q <br /> W <br /> O <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> 0 <br /> N <br /> W <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />