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fest <br /> How to Read a Haz�rdous Waste Mani <br /> Se,1p,mlit,lid,for colmsp"AIM,—ker of each description below. A <br /> O GeneratorlONumber: <br /> you a_baznidu.:s ; Or.Ensure it's listed correctly on the Trani/est. <br /> © Manifest Tracking Number:uninuetra,Ling number pr,m,l n l he containers listed on <br /> manifest <br /> © Generator's Name and Mailing Address,Site Address.and Phone:Ynur h ospital's name,mall'" <br /> and site addresses(if different),and phone number.Ensure these are listed correctly On the <br /> manifest <br /> O Transporter 1 Company Name and U.S.EPA ID Number:The name and U.S.EPA ID number for the <br /> company picking up the waste. <br /> © Transporter 2 Company Name and U.S.EPA ID Number:The name and U.S.EPA ID number for <br /> company that Transporter l'- Ihis waste to(if any).This will only appear On the Desi <br /> Facility copy I f the m a rl" <br /> O Designated Facility Name and Site Address,U.S.EPA ID Number,and Phone:The name.si <br /> r. �J te <br /> address,U.S.EPA ID ,.:,�b.i.e� phone number for the facility to which the waste Willbe Appendix <br /> shipped. <br /> O U.S.DOT Description:Description of waste including International"UN"shipping num Hazardous Waste Self-Inspection Checklists <br /> physical state,specific hazards and chemicals,and DOT Hazard Class. December 2018 <br /> ONumberand Type ofContainers:Number ardtypc ofsh�np�.;.c„.tai,�l>boing Transported. <br /> maYno. t y. r n:Ui_ir � �,sir . � ,, e[hc Transporter. <br /> 0 Total Quantity:T-l a I.e�sf-'v e)of a,�f !11111P for each line. <br /> Unit Wt./Vot:Unit Of;neasure 1-1 Box 11.`Enter"P'for Pounds "G"/or Gallons. <br /> Waste Codes:U.S.EPA and/or State waste codes indicating sT,ec'ihc r hemlca is or hazards pre <br /> ® Generatofs/ONemfs Certllilmtion:Hospital representative's pnnlecITYPcd name and sign, - <br /> affirming Thal the waste described in Boxes 9-13 is what the hospital offered for shipment on <br /> date listed.Makesure that yam know and understand which waste streams are describedby <br /> m those boxes.If you are unsure,ask the nonspoRerto cl <br /> linearify be/ore you sign. <br /> ® in IMUne erAcktlowlcypmamlMgKNpt of Materials:Transporter's printed/typed <br /> signature confi Yped name and <br /> d the wasTe described for transport on the date listed;. <br /> iliry representative's printed/typed na <br /> e manifest on the date listed.TMt <br /> which will be mailed to It <br /> fe Management Bireder(ert►oy <br /> '0It <br /> _ <br /> .z <br /> .. 0 u <br /> Mr”ixsEereO<nr'a wench 3 : - <br /> D <br /> on. e,x ve!a^<: a x i x Y d °. a ^ G a <br /> xEaa a EE =D ; .2 a <br /> �s e,xnv.e<e^n eirxn' lvmn' as<m°l e� <w•v�Oreas.aln<.1 .Sao ln ^U rvmn _ (3�1 D * _ O f� =e <br /> in <br /> ^s <br /> I o a O = 2 V Z^ m A <br /> n 3 O <br /> in <br /> ^ ; 3 m -R 3 3 p <br /> O,ITo! re <br /> rveaxo) n rvwxe) n rvaxn) 3 2 a = Z a e 4 = 3 Z Z 2 ?°' '- 9 0 <br /> acoaos rs 1'.w_., I I u xlm uvvues vaesex n: N m O ,^,Z C 2 a <br /> t ais(M vl rve°xn)RATE o R. <br /> F ' o n H n ._ y <br /> I' m" _ '�e'n z 2 <br /> Z R, z e f <br /> 2 <br /> 0 Z Z <br /> D gg ra Iq 0 Dr: QR <br /> me, xn,v<e e^^ Aoae'e^ eoxo uos a O ?3 3 13'o c' <br /> rz p<enq .0(ymry..^ <br /> Ad,7)' Mxalx sun <br /> soo <br /> ryrxtl le<radewn<.) 11na tymn <br /> n vg8 <br /> R o r` m <br /> D inZ <br /> 2 <br /> H <br /> Z °o°n° 2 <br /> - [ n <br /> R^ <br /> eo <br /> 2 <br /> n CR <br /> n <br /> g <br /> x0l rynmo) ETasTATo xrt(veuxol Esu vuEs vasssxn(ve<txe) g R S A ? a G $R [ m ? $$� p <br /> ._ set^s.xry E�^aerl rv<,Ix^aT. --- Derain Rg c o y o = o &7 <br /> _. ( Sider,Itir(yeuxel a Z a 0 p q O E O <br /> Z ' a Z <br /> I CORRECTIVE ACT...I <br /> M, _ n c" m n� <br /> raW rzs ^ e <br /> 4 O In <br /> m O N n O GCS it <br /> .7 Z u0i 3 9i <br /> m <br /> a AM <br /> 4 - E <br /> Z, <br /> x A <br /> 9 a 2 <br /> C Z <br /> i s Z <br /> 0Z <br /> AOL 1 <br /> ui nr...._ I320a Haxldna <br /> Win Roes I96W EaAve ek Surncxs 14 nr Ms .,w .,, <br /> awnfrara,MD 21M <br />