Laserfiche WebLink
Please print or type. Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 a erator ID N ber 22.Page,, 23 anifest Trac 'n umber <br /> (Continuation Sheet)[/l��) <br /> 24.Generator's Name I <br /> i <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> I U.S.EPA ID Number <br /> ol�) o9st)—�"i,qq I <br /> 26. Tran o 4 pany me ` -& <br /> 27a. 271b.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.Trans rte Acknowledgment of Receipt of Materials <br /> P' yped Ran< lure M t Qyy� ear <br /> ObI(S 0 Al'-N <br /> IL <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> H <br /> r <br /> 35.Discrepancy <br /> J <br /> U <br /> lai <br /> O <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> C9 <br /> co <br /> LU <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />