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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WAST)MANIFEST 121.Generator ID Number r 23.ManiFestTracking Number <br /> Continuation Sheet i <br /> 24.Generator's Name <br /> 25. Transporter Company Name U.S.EPA ID Number ^pp <br /> 26. Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Cass,ID Number, 28.Containers 29,Totai 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity W1.Nol. 31,Waste Codes <br /> O <br /> Q -- -- <br /> w <br /> LU <br /> C7 <br /> 32.Special Handling Instructions and Additional Information <br /> 3 � <br /> 0. 33.Transporter r Acknowledgment of Receipt of Materials <br /> H PrintedlTypeAName Signature f ,- Month Day Year <br /> \J� N r/ / } <br /> a j <br /> Z 34.Transporter Acknowledgment of Receipt of Materials-' <br /> Printed/Typed Name Signature Month Day Year <br /> F <br /> } 35.Discrepancy <br /> U <br /> a <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> cn <br /> LU <br /> LU <br /> c� <br /> EPA Form 8700.22A(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />