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-7 .� <br /> ,nt or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> ,41FORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24,Generator's Name <br /> [.� l. r: r t != <br /> 95l. - <br /> 25. Transporter Company Name �j� � `{IY <br /> U,S.EPA ID Number <br /> 28. Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 2g,Total 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 31.Waste Codes <br /> [>r <br /> O <br /> w <br /> z <br /> w <br /> C� <br /> 32.Special Handling Instructions and Additional information <br /> 33 Transporter Acknowledgment of Receipt of Materials <br /> H Printed Typed Name Signature Month Day Year <br /> 0 <br /> 0. <br /> Z 34 Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name <br /> Signature Month Day Year <br /> 35.Discrepancy <br /> J_ <br /> U <br /> Q <br /> C <br /> LL <br /> Q_ ,-lazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> LU <br /> LU <br /> C3 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />