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Aw <br /> Please Pnnt or type.(Form designed for use on elite 02-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator ID Number 22 Page 23.Manifest Tracking Number <br /> (Continuation Sheet) CARO$0278318 12 of 2 I 011434267FLE <br /> 24.Generator's Name <br /> Dollar`-General #13592 <br /> 25. Transporter Company Name US 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)) <br /> No. Type Quantity Wt.Nol. <br /> -,IF5.UN3077y - taste Environventally hazardous 1 - CF 00005 P 181 D009 <br /> substances, solid, n. o. s. (Mercury, Broken <br /> 0 <br /> W <br /> 2 <br /> W <br /> CD <br /> 32.Special Handling Instructions and Additional Information 5. 110544.(Mercury Containing Wasto..(Broken Eluorescent Lawp)) <br /> 33.Transporter A&jww edgment of Receipt of Materials <br /> H Printed/Typed Name Signature Month Day Year <br /> a I I <br /> Z 34 Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month 7a—y—Year <br /> i <br /> r 35 Discrepancy <br /> J <br /> U <br /> IIL <br /> C3 <br /> 4 36.Hazardouste Repp Man gement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z 1A I I i <br /> W <br /> I I I <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />