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Please print or type.(Form designed for use on elite(12-phch)typewriter.) <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 Generator ID Number22 Page Form Approved,OMB No.2050-0039 <br /> 23.Manifest Tracgng Number <br /> (GonfinuatiodSheeq1.- <br /> 24.Generators Name r k" <br /> t; <br /> 25. Transporter Company Name lam,^ U.S.EPA ID Number <br /> 26. Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(inducing Proper Shipping Name,Hazard Class,ID Number, 28:Containers <br /> HM and Padang Group(if any)) 29.Total 30.Unit 31.Waste Codes <br /> No. ` Type Quantity Wt.Nol. <br /> i <br /> W <br /> 32.Special Handling Instructions and Additional information <br /> 33.Trans der :�' AdmoMedgment of Receipt of Mahmala <br /> W Pnntedrfyped Name <br /> F r•---� `` Signature Month Day Year <br /> z34:Trensporler I AckwMed ment of Receiptf. Materials <br /> Pdnted/fyped Name' Signature <br /> - Month Day Year <br /> C 35.Discrepancy <br /> J <br /> U <br /> LL <br /> O <br /> W <br /> 36.Hazardous Waste Report Management McUwd Cotes(I a.,codes for hazardous waste treatment dispose) and recycling syste <br /> ms) <br /> I <br /> W <br /> O <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />