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Please print or type.(Form designed for use on elite(12-pita)typevAter.) Foran Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.GeneratorlDNurnber 22.Page 23,Manifest Tracid®g Numb <br /> (Confbtuatlon Sheet) <br /> 24.Generator's Namq, <br /> 25.Transporter Company Name U.S.EPA ID Number <br /> U.S.EPA ID Number <br /> 26.Transporter Company Name <br /> 27a. 27b.U.S.DOT Desaiptbn(including ProW Shipping Name,Hazard Gass,ID Number, 28.Containers 29.Taal 30.Unit <br /> 31.Waste Codes <br /> HM and Packing Group(8 any)) No. Type Quantity WL/Vol. <br /> w <br /> z <br /> U <br /> 32.Special Handling Instnrcbons and Additimal Information <br /> i <br /> Z 33.Tran Acimaeied mantofRete dNYateriMS <br /> W PrinftdTy*Namo Signature Mods Day Yesr <br /> 34.Transporter AcknavvIedgment of Receipt of Materials <br /> Printedflyped Name Signabre Month Day Year <br /> r <br /> 35.Discrepancy <br /> V <br /> G <br /> 4 36.Hazardous Waste Report Management Method Codes li.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> f9 <br /> Lf <br /> ut <br /> O <br /> EPA Form 8700-22A(Rev.3-05) Preview editions are obsolete. GENERATOR'S INITIAL COPY <br />