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Pleftse print or pe. Form designed for use on elite 12 itch ewriter. Form Approved,OMB No.2050-0039 <br /> AL UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) CAL92p8460$8 <br /> 24.Generator's Name Ooc;to+s Hospital Manteca <br /> 120 5 E North St <br /> Wnll CA 95336 <br /> F569 304 4093 <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> 26, Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(if any) No. Type Quantity Wt.Nol, 31.Waste Codes <br /> LIN1479,Waste O)ddiang soad,ri(Contains Silver Nitrate, D001 DO 11 551 <br /> X Potassium Nitrate),5.1 ,11 DF P <br /> ¢ I <br /> O <br /> Q - <br /> fY <br /> w <br /> Z <br /> w <br /> 32 Special Handling Instructionsan Additional Information <br /> 5) 119239 ERG#14t] r) X5) <br /> ¢ 33.Transporter Acknowledgment of Receipt of Materials <br /> VJ Printed/Typed Name Signature Month Day Year <br /> ccO <br /> CL <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> > 35.Discrepancy <br /> t— <br /> J <br /> U <br /> Q <br /> LL <br /> O <br /> a36.Hazarous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal and recycling systems) <br /> 2 ry r <br /> U) <br /> W <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />