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Please print or type.(Form designed for use on elite(12-pitch)typewriter,) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 2J.Mantlast Tra 13 Number <br /> (Continuation Sheet) CA I— oni 7aG <br /> 24.Generators Name <br /> U.S.EPA ID Numbe, <br /> 25. Transporter Canpany Name e aC V D 7 O 5 <br /> Us EPA ID Number <br /> 26. Transporter— Company Name <br /> 27a. Tib.U.S.DOT Deunptbn(inoiuong Proper Shipping Name,ll r Gass.t0 Numbv 2e.Canuimrs 29.Total 30.Und 31.wane Codes <br /> HM and Packing aro (it any)) No. Type GuanMy mina <br /> z <br /> QO <br /> K <br /> w <br /> z <br /> w <br /> O <br /> R <br /> MA <br /> B VIR <br /> p} mcia ACA <br /> 32.Special Handling Ins Wdeons am Additional Inform boo, <br /> 33.Tmnsp" Arkria.Medgroant 0 Receipt of Materials Mon- Day Veal <br /> W Printed7Typed Name Sgrmbrce <br /> �Z /3 <br /> o <br /> d <br /> z 3d.Transport _. rnenl of Recegl Mea <br /> PrmedTyped Name Sgnatum MOMn Day Year <br /> H <br /> r 35.Dwepatwy <br /> J <br /> U <br /> Q <br /> LL <br /> Q36.Hazardous Waste Repos Management Method Codes(Le.,miles for haaaNws waste treatment,disposal,and rerytling systems) <br /> z <br /> O <br /> N <br /> W <br /> 0 <br /> EPA Form 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />