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0 <br /> Please Drint or Form desi ned for use on elite 12- itchtypewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21,GeneaterlDNumber 22.Page 23.Manifest Tmcking Numher <br /> (Continuation Sheet) Z�tZCjq6Z L� <br /> 24.Generators Name <br /> /tic 1 <br /> U.S.EPA ID Number <br /> 25. Transporter Company Name O <br /> 26.Tanspoder Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Ship og Name,Hazard Gass,ID Number, 26.Containers 29.Total 30,Unit 31.Waste Codes <br /> HM and Packing Group(4 any)) No. Type Quantity WtM. <br /> fY <br /> O <br /> C <br /> z <br /> fW'J <br /> gAN JOA UIN CA NN <br /> HEALTH EP <br /> 32.Spedal Handling Instmctions and Addidonal Information <br /> 33.Ta . AckinaNtedgmentofRoomptoilviaterials <br /> r Printedlfy me SigraW Month Day Year <br /> fl� /2 1 13 i <br /> z 34.Transponer Adcnavled menl of Receipt of Materials <br /> Prudedfryped Name �.. ,/1� S9 � rr ay Year <br /> 124ILL <br /> 35.Discrepancy <br /> J <br /> U <br /> LL <br /> 4 36.Hazardous Waste Report Management Method Codes(e.,codes for hazardous waste treatment,disposal,aM recycling systems) <br /> Z <br /> N <br /> W <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />