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Please print or type. (Form desianed for use nn efite II9-nitchl t„no,. m— t <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />- —.1 <br />21. Generator ID Number <br />- <br />22. Page .: <br />t-orTn Approved. OM8 No. 2050-0039 <br />; 23. Manifest Tracking Number <br />:., 7 – I <br />24. Generator's Name _� f (A- <br />16 r..I A Go iT7 Tst �& <br />;;-1LL <br />25. Transporter Company Name U.S. EPA ID Number <br />26. Transporter Company Name U.S EPA ID Number <br />27a. <br />HM <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Containers <br />29. Total <br />Quantity <br />30. Unit <br />Wt./Vol. <br />31. Waste Codes <br />No. <br />Type <br />Q <br />O <br />W <br />Z <br />W <br />I <br />32.S pedal Handling Instructions and Additional Information <br />33. Transporter Acknowledgment of Receipt of Materials <br />LU <br />Printed/Typed Name Signature Month Day Year <br />to <br />34. Transporter _ AdRnowled meet of Receipt of Materials <br />H <br />Printed/Typed Name Signature Month Day Year <br />J <br />U <br />Q <br />LL <br />O <br />W <br />C7 <br />35. Discrepancy <br />36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />w <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />