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type . ( Form designed for use on elite ( 12- itch). ewritec Form A roved . OMB No. 2050-0039 <br /> 21 . Gen ator ID Number 22. Page 23, Manifest Trackirg Number <br /> rRM HAZARDOUS WASTE MANIFEST c � <br /> (Continuation Sheet) <br /> Generators Name Y <br /> I i CeIti° A itt. k7a <br /> - U .S. EPA ID Number <br /> 25. Transporter Company Name <br /> U .S . EPA ID Number <br /> 26. Transporter Company Name <br /> 27a 27b. U.S . DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 28, Containers 29. Total 30, Unit 31 . Waste Codes <br /> HM and Packing Group ((Jany)) No. Type Quantity Wt.Nol. <br /> )`'id (,yV �e ti lr'} �-re j *!`7 f'6.-w� C'fi 5 S <br /> -ix t'.f3 ,I [ f.%'tf t`C. l.1 S f e- - ... . - '----- _ <br /> /'' <br /> d r.r / Y <br /> A. !? i d10 <br /> I✓ `• il.fi./ 'j �C� 0 3 *r. ',.:'t i '✓ <br /> p v., <br /> CY <br /> LU <br /> Z <br /> w <br /> it <br /> EP 0 6 X016 <br /> i i j _ t - <br /> r . ' <br /> 32. Spec <br /> . G' �' t3CmA/r/0t � ' r r`Se� T < � � � r �a C c � �� f �l -. t ! ; f � 'r.•, � � � <br /> �gl � � / Y� f1 � •$• G � "` f vt � � # � �` <br /> � L . iC1f slt�f .5 _ t ) > �s f t ti �f < Z I 5`r c `sf <br /> 33. Transporter AcknolMed ment of Receipt of Materials <br /> H Printedryped Name Signature Month Day Year <br /> rY <br /> O <br /> CL <br /> z 34. Transporter . Acknowledgment of Receipt of Materials <br /> < PrintedrTypeq Name Signature Month Day Year <br /> H <br /> 35. Discrepancy <br /> derU <br /> Q 36 Hazardous Waste Report Management Method Codes (i.e. , codes for hazardous waste treatment, disposal, and recycling systems) <br /> :wLu <br /> EPfptlt 8700 22A ( Rev. 3-05) Previous editions are obsolete . DESIGNATED FACILITY TO GENERATOR STATE ( IF REQUIRED) <br /> L : <br />