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Please print or type. Form designed for use on elite 12-pitch typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1 21.Generator ID Number 7age 1 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 <br /> U.S.EPA ID Number <br /> 27a. 271b.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 /> Q <br /> W <br /> Z <br /> W <br /> I <br /> i <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> W Printed/i ed Name <br /> yP Signature Month Day Year <br /> irO <br /> a <br /> y 34.Transporter Acknowledgment of Receipt of Materials <br /> C< Printed/Typed Name Signature Month Day Year <br /> 35.Discrepancy - - <br /> t— <br /> J <br /> U <br /> a <br /> a36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal and recycling systems) <br /> Z <br /> O <br /> N <br /> W <br /> D <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> GENERATOR'S INITIAL COPY <br />