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Please orint ort Form designed for use on elite 12- itch writer. Form Approved. MB No,2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Gene r ID Number 22.Pa 23,Manifest Tracking Number <br /> (Continuation Sheet) C,116 o© D 33� r /�e� <br /> 24.Generator's Name �� A <br /> CW <br /> /) U.S.EPA IDN ber <br /> 25. Transporter _ Company Name `�C,.� n-1 �9�Z <br /> 26. Transporter_ Company Name U.S..FPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29,Total 30,Unit 31. ste Codes <br /> HM and Packing Group(d any)) No. Type Quantity W[Nol. <br /> O <br /> t, <br /> LLJ <br /> Z <br /> O <br /> 32.Special Handling Instructions and Additional Information <br /> LX 33.T nrter AdcnoWe ment of Receipt of Materials <br /> w PrintedfTyped Nam Signature Mont 1 Day Year <br /> 011-7 <br /> a <br /> Z 34.Transporter Acknowledgment of Rece t of Material <br /> Printecirl-yped Name signaLre Mon Day Year <br /> t— <br /> 35.Discrepancy <br /> U <br /> Q <br /> LL <br /> D <br /> 111 <br /> a 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> O <br /> U) <br /> LU <br /> n <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STA (IF REQUIRED) <br />