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Please print or type. ' Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21,Generator lD Number 22.P e 23.(Manifest Tracking Number <br /> (Continuation Sheet) i A L U 0 0 �� U a !3 ff �j rP <br /> 24.Generatoes Name <br /> 25. Transporter Company Name U.S.EPA ID Number (� ` <br /> U.S.EPA ID Number <br /> 2E Transporter Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers „PrTotal 30.Unit <br /> HM and Pad ing Gro`uu(iT any)) No. Type Quanldy Wl.Nol. 31.Waste Codes <br /> W � <br /> Wr ♦ // <br /> 32 Special Handling instructions and Agonal Information <br /> 33.Transporter Aduawled merd of Recel i of Materials <br /> W Primed/Typed Name ' Signature / .-.�_.. Month Day Year <br /> h, <br /> I-- r <br /> O <br /> a <br /> Z 34.Transporter Aclaw•.dedgmerd of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> 35,Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> LU <br /> a35.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> 0 <br /> rn <br /> W <br /> 0 <br /> EPA Form 8700.22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />