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Please print or type. Form designed for use on elite 2-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) CAR600247213 2 of 2 008553873FLE <br /> 24.Generator's Name <br /> Safeway NorCal #1769 <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 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 5.UN3249, Waste Residue Last Contained, 1 CF 00001 P 311 P001 <br /> Medicine, solid, toxic, n. o. s. (Warfarin), <br /> A. I. PG III ERG#151 <br /> 6.UN3249, Waste Medicine, solid, toxic, n.o.s. 1 CF 00001 P 311 D006 D007 <br /> (Selenium, Silver), 6. 1, PG II, ERG#151 <br /> naii <br /> 7.Non RCRA hazardous waste, liquid (Personal 1 DF 00098 P 331 <br /> Care Products), <br /> O <br /> w <br /> z <br /> LU <br /> C7 <br /> i <br /> 32.Special Handling Instructions and Additional Information 5. 101445(Gen.Status Determination Excludes Container Wt. ) CNT:' <br /> 40 6. 101448(RX Toxic Solids) 7. 100493(State Regulated Liquids) <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> F Printed/Typed Name Signature Month Day Year <br /> O <br /> a <br /> U3 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> F <br /> 35.Discrepancy <br /> J_ <br /> V <br /> Q <br /> LL <br /> O <br /> Q 36.Hazardo aste Report Management Method Codes(i.e.,codes for hazardous waste treatment,P7, <br /> al and re cling systems) <br /> Z L <br /> N <br /> W <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 00-22a�12y3 CAL2!P)�800'� ..S4 718 _ 040896(84.. M _,. _ ,.;: �PR�7�i7 SD072$17 ,.; <br />