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ry <br /> Please print or type. Form designed for use on elite12- itch typewriter.) 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 /> r <br /> .. <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> 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-Packi*Group(if-any)- 31.Waste Codes <br /> - _ --No. Type _Quantity Wt_.Nol. <br /> i <br /> t <br /> O <br /> tr <br /> W <br /> Z <br /> W <br /> 32.S pecial Handling Instructions and Additional Information <br /> cc 33.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> Z 34.Transporter ` ; Acknowledgment of Receipt of Materials <br /> Printed/Typed Name' Signature Month Day Year <br /> > 35.Discrepancy <br /> H <br /> J <br /> d' \ <br /> Q 36.Hazardous Waste Report Management Method Codeg(i.e.,codes for hazardous waste treatment,disposal and recycling systems) <br /> Z�Rr� <br /> V <br /> to <br /> iW` <br /> O <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> NEN NRiA. -Y <br /> ERATNR'S 1 <br />