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Please print or type, Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST L21Generator ID Number 22.Page 23.Ma 'fest Tracking um er <br /> (Continuation Sheet) .� <br /> 24.Generator's Name <br /> 25. Transporter Company Naro P U.S.EPA ID Number <br /> i c !SL <br /> k <br /> 26. Transporter Company Name <br /> U.S.EPA ID Number <br /> 27a. 271b.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(if any)) No. Type Quantity Wt.Nol. <br /> i <br /> O <br /> w <br /> LU <br /> z <br /> 32.S pecial Handling Instructions and Additional Information <br /> 33.Transporter Acknowled ment of Receipt of Materials <br /> Fw— Printed/Typed Name } Signature Month Day Year <br /> n 13 1 <br /> z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> } 35.Discrepancy <br /> f— <br /> J <br /> U <br /> Q <br /> LL <br /> 0 <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 /> O <br /> rn <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />