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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number Form Approved.OMB No.2050-0039 <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> i <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> 26.Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity WLNoI. 31.Waste Codes <br /> ,r <br /> O <br /> W <br /> Z <br /> W <br /> C7 <br /> I I <br /> I <br /> {{I <br /> I t <br /> � I <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> F PrintedlTyped Name Signature Month Day Year <br /> O <br /> IL <br /> z 34.Transporter Acknowledgment of Receipt of Materials <br /> PrntedlTypedName Signature Month Day Year <br /> t— <br /> r 35.Discrepancy <br /> F- <br /> J <br /> U <br /> LL <br /> O <br /> W <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> O <br /> Uw <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />