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Please print or type. Form designed for use on elite 12- itch typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) �� Cls1 <br /> 24.Generator's Name <br /> 25. Transporter Company Name <br /> U.S.EPA ID Number <br /> -T M� ono o5o 2 <br /> 26. Transporter Company NameC /ems .1 I4� r�O U.S.EPA ID Number Z � <br /> C 1 39J-2 <br /> 27a, 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(if any)) 31.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> i <br /> 1 <br /> i <br /> i <br /> O <br /> Q <br /> w <br /> z <br /> LU <br /> C7 <br /> I <br /> I <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> F Printed Typed N e Signature Month Day Year <br /> a Q <br /> 0 I7 <br /> a <br /> Z 34.Transporter Acknowlecciment of Receipt of Materials <br /> Printed/Typed Nam nature Month Day Year <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> LU <br /> W <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> c7 <br /> ti <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />