Laserfiche WebLink
Please print or tvpe. Form designed for use on elite 12- itch t ewriter. Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 . Generator ID Number _ 22. Page 23. Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24. Generator's Name , <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)) Ne. Type Quantity Wt.Nol. 31. Waste Codes <br /> � o <br /> O ~- <br /> w <br /> Z <br /> ----_.. <br /> 32, Special Handling Instructions and Additional Information <br /> 33. Trans orar _ Acknowledgment of Receipt of Materials <br /> W Print N ed Name <br /> YP Signature Month Day, Year <br /> O <br /> a <br /> Z 34. Trans Drier Acknowledgment of Receipt of Materials - <br /> Pdntedryped Name Signature - Month Day Year <br /> F— <br /> Y 35. Discrepancy <br /> U <br /> W <br /> 36 Hazardous Waste Repel Management Method Codes (i.e., codes for hazardous waste treatment, disposal, andrecyclingsystems) - <br /> z <br /> f9 <br /> ti <br /> w <br /> 0 <br /> EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />