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Please print or type. Form desi ned for use on elite 12 itch t ewriter. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <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 Wt./Vol. 31.Waste Codes <br /> O <br /> a <br /> W � <br /> Z <br /> W <br /> @3 <br /> `0. <br /> 4*w <br /> 32.Special Handling Instructions and Additional Information <br /> cc 33.Transporter Acknowledgment of Receipt of Materials <br /> I.— Printed/Typed Name Signature Month Day Year <br /> IrO <br /> a <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> 14 Printed/Typed Name Signature Month Day Year <br /> 35.Discrepancy <br /> J_ <br /> Q <br /> I <br /> a36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal and recycling systems) <br /> Z <br /> C7 <br /> LU <br /> v <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOfi <br />