Laserfiche WebLink
Please print or type, Form designed for use on elite(112-pitch)typewriter.) Form Approved.OMB No.2050.0039 <br /> uniber <br /> UNIFORM HAZARDOUS WASTE MANIFEST D r '� P e 23ji)I�pa Tr n r � Y <br /> (Continuation Sheet) <br /> 24.Generators Name <br /> 25.TransporterU.S.EPA 10 Number <br /> i�Company Name �r ,t�j <br /> V h 1 U.S.EPA lD Number <br /> 26.Transporter Company Name { YO `63 <br /> Z� <br /> 2Ta. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 34.Waste Codes <br /> HM and Packing Group(if any)) No. Type Ouanuw Wt.Mol. <br /> IY <br /> f <br /> W <br /> z <br /> W <br /> 19 <br /> i <br /> 32.Special Handling Instructions and Addiddnal IMormaean <br /> 33,Trans Acknowied meet of Receipt of Matedals <br /> F PrintetllType Signa Month Day Y <br /> R- U 1k <br /> Z 34.Trans Q Acknowledgment of Recei 1 of Materials <br /> dd PrintaCyped Nam 5 Year <br /> •- - <br /> 35.Discrepancy <br /> J <br /> U <br /> a <br /> 0 <br /> a36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> C7 <br /> LU <br /> Q <br /> EPA Form 8700-22A(Rev.3-05)Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />