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Please nri;t or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.GeneratorlDattoNumber 22.P eJ 23.Manifest Tracking Number 7 /, _ <br /> (Continuation Sheet) O�T . a 7 % T <br /> 24.Generators Name <br /> 25.Transporter Company Name ' U.S.EPA ID Number <br /> U.S.EPA ID Number <br /> 26.Transporter _ Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> 31.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity WLNoI. <br /> i— <br /> i <br /> I <br /> i <br /> I <br /> � I <br /> 0 <br /> I I <br /> w I <br /> z <br /> LU <br /> 0` <br /> I E <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Malerials <br /> w PrintedlTyped Name i+ Signature Month Day Year <br /> T <br /> M <br /> Z <br /> 11 <br /> 34.Transporter Acknowledgment of Receipt of Materials <br /> < Pdnted/Typed Name Signature Month Day Year <br /> f- <br /> r 35.Discrepancy <br /> J_ <br /> U <br /> Q <br /> LL <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> S2 <br /> w <br /> ca <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. <br />