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Plaaca nrintnrtvna <br />Form ADDroved. OMB No. 2050-0039 <br />EPA Form 8700-22A (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's a -MAN =EST SYSTEM <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. Generator ID Number <br />vim!✓ <br />22. Pae <br />23. Ma t1Tra in Nu r <br />t 1 <br />24. Generator's Name <br />1 <br />25. Transport, Coplpan ame ^ f U.S. EPA ID Number <br />Com -off e 5�In 019,o Z� <br />26. Transport, om an a U.S. EPA ID Number <br />27a. <br />HM <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Containers <br />29. Total <br />Quantity <br />30. Unit <br />Wt.Nol. <br />31. Waste Codes <br />No. <br />Type <br />A//") <br />O <br />W <br />z <br />W <br />L7 <br />32. Special Handling Instructions and Additional Information <br />33. Transporter Acknowledgment of Receipt of Materials <br />F <br />a <br />Printed(ry am Signature Month Day Ye r <br />`— 1 <br />Z <br />34. Transporter Acknowledgment of Receipt of Materials <br />F <br />Printed/Typed Name Signature Month Day Year <br />J <br />U <br />G <br />35. Discrepancy <br />Q36. <br />z <br />O <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />rn <br />w <br />0 <br />EPA Form 8700-22A (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's a -MAN =EST SYSTEM <br />