Laserfiche WebLink
Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> e7 q <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> SAME <br /> Tp �+ A /^yT p TpA�1 ` U.S.EPA ID Number Q <br /> 25. Transporter Company Nam TRI STATE MOT6 !FSMSIT CO. M`1�380-0 <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 36,Unit <br /> 31.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity WtNol. <br /> rY <br /> TPn <br /> 0 <br /> W <br /> z <br /> w <br /> [9 <br /> 32.Special Handiing Instructions and Additional Information <br /> 33.Transporter 5 Acknowledgment of Receipt of Materials <br /> w PrintedJTyped Name Signature Month Day Year <br /> F— <br /> Cedric Bames 4 , CL LA I 0A1 610 1 l <br /> IL <br /> 34.Transporter Acknowledgment of Receipt of Materials <br /> Printedfryped Name Signature Month Day Year <br /> H- <br /> 35.Discrepancy <br /> J <br /> U <br /> a <br /> 0 <br /> Q36.Hazardous Waste Report Management Method Codes(l.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> [7 <br /> co <br /> LU <br /> v <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO EPA's 9-MANIFEST SYSTEM <br />