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UNIFORM k ZARDOUS 21 . Generators US EPA ID f3"tr ~ ;,-Manifest Document No. 22 . Page Information in the shaded
WASTE MANIFEST
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23 . Generator's Name
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24 . Transporter Company Name 25 . US EPA ID Number N State Transporters I D
0 Transpo rt er's Phon e
26. Transporter Company Name 27. US EPA ID Number P . State Transporters I D
0 . Tran=porters Phon e
28 . US DOT Description (Including Proper Shipping Name, Hazard Class,, and /D Number)
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29 . Containers
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30 .
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T . Handling Codas for Wastes Listed Above
32. Special Handling Instructions and Additional Information y jf,:,,-, /^l tlG- ~f> p 7 '~ i i'Je 6-t7`}+~ ~. ~ SK # 829t,
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T 33. Transporter , Acknowledgement of Receipt of Materials Dat e
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Printed/Typed Name Signature Month Day Year
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0 34. Transporter Acknowledgement of Receipt of Material s
R Printed/Typed Name Signature Month Days Year
F 35 . Discrepancy Indication Space
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Style CF18-6 Labelmaster, An American Labelmark Co ., Chicago, IL 60646 (800) 621-5808
W PRINTED ON RECYCLED P,~PE R
USING SOYRE,ON INN re
EPA Form 8700-22A (Rev. 9-88) Previous editions are obsolete .
TRANSPORTER #1
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