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Pkwtitt t . Form desicined for use on elite12 ' writer. Form Appmvid.OMB No.20500039 <br /> t)US WASTE MANIFES? <br /> 1�1.Gera�r ID 22. 23.Manifest Tracking Number <br /> ``Yzttitierai ion Sheet) (� <br /> Name, <br /> a <br /> 6 T -yCnY N U.S.EPA ID Number <br /> c G `ants c. b u (�), <br /> Tparry Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Stripping Name,Hazard Class,ID Number 28.containers 29.Total 30.Unit <br /> HM and Packing Croup(d any)) 31.Waste Codes <br /> No. Type Quantity Wt.Noi. <br /> r"mak <br /> R <br /> W <br /> Y <br /> 32.Special HardN Instructions and Additional Information <br /> enx <br /> 33.Transporter t of Receipt of MaMais <br /> tau Pdntedfryped Name a Slilnature <br /> Mom) Day Year <br /> IL <br /> - J31 <br /> Z 34.T ofter AtMAment of R of MaMrials <br /> 35.Discrepancy � w"' � /� <br /> V <br /> ra <br /> W <br /> Q 36.Hazardous Waste Report tkMagement Medrod Odes(i.e.,cedes for hazardous waste treatment,disposal,and recycling systerns) <br /> Z <br /> t'? <br /> rn <br /> G <br /> EPA Form 8700.22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />