Laserfiche WebLink
Please Ddnt or Form designed for use on elite 12- itch)typewriter.) Form Approved.OMB Na.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST Ge rator MN22.Page 2 t T u bet <br /> (Continuation Sheet) <br /> 24.Generators Name <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> r; -s fairs a 49- <br /> 26. Transporter Company Nam U.S.EPA ID Number <br /> � diia� �t►-u�c>p.� � Zzzsv <br /> 27a. 27b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 23.Totai 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity M./Vol. 31.Waste Codes <br /> O <br /> w <br /> Z <br /> W <br /> t7 <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transpotme.—Acknowledgment of Receipt of Materials <br /> w Printed/Type Signature <br /> OC Month Day Year <br /> O 111 17- / <br /> a <br /> Z 34.Transporter -Acknowledgment of Receipt of Materials <br /> PrintedlTyped Na <br /> ignalure <br /> Month ffa—y Year <br /> 35.Discrepancy <br /> Ca <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 /> O <br /> to <br /> W <br /> O <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />