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Please print of type. Form designed for use on elile 12• itch) writer. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) 61)IM&IM4569 20(2 0/702962SJR <br /> 24.Generator's Name ;r <br /> 2690 Aufyp[l�/pZq w,, <br /> i}.r �A 9 spa <br /> A <br /> 25. Transporter 3 Company Name Number <br /> Number <br /> 26. Transporter Company Name <br /> 27a 27b.U.S.DOT Descrption(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quanlity Wt.NoI. <br /> O <br /> w <br /> Z <br /> W ' <br /> t� <br /> Ito x"', <br /> �t <br /> 32.Special Handling Instructions and Add lona)Informallon <br /> 33.Transporter J Acknwledqmert of Receipt of Materials <br /> w printed/Typed Name 1 Signature Morlh Day Year <br /> a � - LAZ / <br /> a <br /> Z 34.Trans orter cknowed mento ecei tofMaterials <br /> PrintedRyped Name Signature Montay ear <br /> N <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> O <br /> Q36.Hazardous Wasle Report Management Alethod Codes(i.e.,codes for hazardous waste treatment,disposal,and recyding systems) <br /> z , <br /> c� <br /> V) <br /> w <br /> v <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />