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Please print or type. <br /> UNIFORM HAZARDOUS WASTE MANIFEST emror I / 22.P e 23.Manifest Trocki g Numbe/r Form Approved.OMB No.2050-0039 <br /> (Continuation Sheet) sr <br /> 24.Generator's Name AOL— V <br /> 9 / at�� — — <br /> CCn <br /> 25. Transport Company Nam I U.SEEA ID Nugiber <br /> 26. Transporter Company Name U.S.EPAID Number <br /> 27a. 27b.U.S.DOT Descripbon(including ProperShipping Name,Hazard Class,ID Number, 26.Containers 29.Tohl 30.Unit <br /> HM and Packing Group(g any)) No. Type Quantity Wt.Nol. 31.Waste Codes <br /> rY <br /> aO <br /> K <br /> w <br /> z <br /> W <br /> U <br /> 32.Spedal Handling InshucM1wis and Addigonal Infonnagon <br /> 33.Trans AdmoWfedgment of Receipt of Materials <br /> w P y ~( r Sign re Month <br /> .. ,IDay Year <br /> aZ4- 4 / ✓ J� <br /> = 34.Tmnsponer Acknowledgment of Receipt of Materials <br /> Pnnted/Typed Name Signature Month Day Year <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> O <br /> W <br /> z36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O <br /> fq <br /> W <br /> O <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO EPA's e-MANIFEST SYSTEM <br />