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Forth Approved.OMB No.2050-009¢.Explren 9.90.99 <br /> UNIFORM HAZARDOUS 21. Generator's US EPA ID No. Manifest Document No. Off, Page Information in the shaded <br /> WASTE MANIFEST areas is not required by Federal <br /> law. <br /> (Continuation Sheet) <br /> 23. Generator's Name L. State Manifest Document Number <br /> M.State•Generators fD <br /> f . <br /> 24. Transporter Company Name 25. US EPA ID Number IN. State Transporter's ID <br /> 0. Transporter's Phone <br /> 26. Transporter Company Name 27. US EPA ID Number I P. State Transporters ID <br /> O.Transporter's Phone <br /> 29. Containers 30. 31, R. <br /> 26 US DOT Description (Including Proper Shipping Name, Hazard Class,and ID Number) Total Unit Waste No. <br /> No. Type Quantity Wt/Vol - <br /> a. ;, <br /> / r y <br /> V <br /> A-04- 1. ')( 411,,11 ?26!6 <br /> r -7 <br /> 0. rv"w At .•'l+7 1:'r"l.f� e.A ';'i:l l llj fl '} -' f <br /> t.i:�6 „yq f ;. t •.:i ,,V. ir.. ;'; % ra -i C- ' . L•. ` ,. . <br /> a d. <br /> N <br /> e <br /> e e• <br /> T <br /> 0 <br /> n <br /> t <br /> 9 <br /> h. <br /> i. <br /> 1 <br /> S.Handling Codes for Wastes Listed Above <br /> a s ) 'r t b, c. Cl. e. f. g. <br /> h. i. J. <br /> 32. Special Handling Instructions and Additional Information r : Y '' ,r% ; 'r n•�� <br /> // / <br /> �� Pc e, r2 err <br /> r. <br /> T 33.Transporter_Acknowledgement of Receipt of Materials V Date <br /> PrintecUTyped Name Signature Month Day Year <br /> N <br /> a <br /> 0 34.Transporter_Acknowledgement of Receipt of Materials Date <br /> 7 Printed/Typed Name Signature Month Day Year <br /> R <br /> } 35. Discrepancy Indication Space <br /> FF ------ <br /> EPA Farm 8700-22A(Pev.9-e9)Previous atlitions ere obsolete. <br /> FILE COPY OR STATE COPY <br />