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' Please print or type.(Form designed for use on elite(12-pitch);typewrite,J Form Approved:OMB No,2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 Generator lb Number 22.Page 23 Manifest Tracking Number t 5 <br /> (Continuation Sheet) s' �.. ,�I(1 - ,�I tI�L�� J`i l ._ <br /> 24.Generator's Name <br /> 25. Transporter - _- Company Name <br /> U.S.EPA ID Number <br /> f• <br /> 26 Transporter- Company Name i, C'1 1 5 EPA ID Number <br /> 1, vl: 7 � it l'{-�- £ ' ( t I {i 1 V L.' <br /> 27a. 27b.U%,DOT Description(including Proper Shipping Name,Hazard,Class,ID Ndmber 28.Containers 2g Total 30.Unit <br /> HM and Ping Group(if any)) No. Type Quantity Wt.;Vol. 31.Waste Codes <br /> 0 <br /> TT <br /> „ r <br /> / 1 <br /> 0* <br /> .�_ - 4:'r 41 <br /> .,... // l� - . ....._...._.. ._.__ _..-...-.. ._. .. .. - _. <br /> ENVIR NM MM-HE �fH <br /> t <br /> I _ <br /> I <br /> 32.Special Handling Instructions and Additional Information <br /> f <br /> — --= --, V., <br /> s <br /> IX 33.Transporter 1_Acknowledgment of Receipt of Materials <br /> Printed Typed Name Signatu — — ---..W Month Day Year <br /> Z 34 Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name 1Slgn r i Mon Day. Year <br /> } 35 Discrepancy t <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling sysKems) <br /> 0 <br /> V) <br /> w <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br /> a'�S.>a <br />