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Please print or type. Form designed for use on elite 12 itch typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1 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(includingProper Shipping28.Containers <br /> HM and Packing Group(ifany) p Name,Hazard Class,ID Number, 29.Total Wt Unit 31.Waste Codes <br /> No. Type Quantity Wt./Vol. <br /> i <br /> O <br /> LUz <br /> W <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> LLJ Printed/Typed Name Signature Month Day Year <br /> ccO <br /> a <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> ¢ Printed/Typed Name Signature Month Day Year <br /> F- <br /> 35.Discrepancy <br /> i <br /> 4 <br /> 0 <br /> W <br /> a 36.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 /> O <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> GENERATOR'S INI'fG4L COPD <br />