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0 <br />Please print or Form designed for use on elite 12- itch ewriter. <br />10 <br />Form Approved. OMB No. 2050-0039 <br />EPA Farm 8700-22A (Rev. 3-05) Previous editions are obsolete. [ DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation <br />21. Generator ID Number C <br />22. P 23. Manifest Tracking Number C <br />24. Generators Name <br />0411c <br />s t e I �c <br />25. Transporter _Company Name <br />Ole <br />C -(L <br />U.S. EPA ID Number <br />/�v ��, \� n <br />26. Transporter_ Company Name <br />US EPA ID Number <br />27a. <br />HM <br />27b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group(g any)) R <br />28. Containers <br />29. Total <br />Quantity <br />30, Unit <br />WLNal. <br />31. Waste Codes <br />No, <br />Type <br />K <br />Oa <br />K <br />W <br />2 <br />b7 <br />32. Special Handling Instructions and Additional Informabon <br />r <br />o <br />33, Transporter A ment of Receipt of Matenels <br />Panted yped Name <br />rte Month Day Year <br />a <br />2 <br />34. Transporter AcknoMedgmant of Receipt of Materials <br />H <br />PrinteNTyped Name <br />nature ay ear <br />J <br />U <br />LL <br />35, Discrepancy <br />Q36. <br />t9 <br />Hazardous Waste Report Management Me" Codes (ie., codes for hazardous waste treamtenb dO <br />sal, and recycling systems) <br />N <br />w <br />0 <br />EPA Farm 8700-22A (Rev. 3-05) Previous editions are obsolete. [ DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />