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onnt or type.(Form designed for use on elite(12-path)typewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORMHAZARDOUS WASTE MANIFEST 21.Ger�amtor IDNumber 22.Page 23.Mt Tracking Number <br /> (Continuation SheeQ ft D (C'l w 1 S O j v Z ,2 anfles66b--<t47_7 e2 WS <br /> 24.Generators Name <br /> D of <br /> 25, Transpatler Company Name U.S.EPA ID Number <br /> f r� C;lN1cxL rcel, -noN ; nf� orra 63 ►3� s <br /> 26. Transporter_ Company Name U.S.EPA ID Number <br /> 27a, 276.U.S.DOTDescrpwri(inckrding Pmper Shipping Name,Hazard Class,ID Number, 28.Comainem <br /> 29.Total 30.Unit <br /> t HM and Packing Group(ti any)) No. Type Quantity WtivOL 31.Waste Codes <br /> 1 <br /> K <br /> O <br /> 6 <br /> LU <br /> z i <br /> cwa I I <br /> t <br /> I <br /> I <br /> I <br /> I <br /> f I <br /> I I <br /> I i <br /> I <br /> I <br /> I <br /> 32.Spatial Handling InsWcOons andAdddional Inhrtnall� <br /> K 33.Transpoia Aokrw.4adgment of Receipt or Nateials <br /> W Printedffyped Name <br /> Signature 9 Month Day Year <br /> f MCn�ra� 3 IZ <br /> 2 34.TmrspoMr Acknowledgment of Receipt of Materiats <br /> PnnletlRyped Name Signature - Month Day Year <br /> 35.Oiscrepancy <br /> ._I <br /> V <br /> LL <br /> W <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,cries for hazardous waste treatment disposal,and recytling systems) <br /> z <br /> cs <br /> w <br /> ❑ <br /> EPA Form 8700-22A(Rev.3-05) Previous editions we obsolete. DESIGNATED FACILfTYTO DESTINATION STATE(IF REQUIRED). <br />