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Please print or type . Form Approved . OMB No . 2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1Ge rata ID Num r22. Pag Ma (fest Tracking Number I ^ e <br /> (Continuation Sheet) \ W� � <br /> 24 , Generators Name <br /> 25, Transportks— Company Name r -- S EPA ID Number _ <br /> F> ,=! 3� 9 <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 1 29. Total 30, Unt 3I , a , te Cal <br /> HM and Packing Group (if any)) NO, Type Ouanlity WllVoI_ <br /> f <br /> s � <br /> I <br /> ( i <br /> K <br /> O <br /> rY <br /> w <br /> z <br /> w <br /> 0 <br /> i <br /> i - - <br /> i <br /> c <br /> 32 Special Handling Instructions and Additional Information <br /> 33. Transporter LAcknowledgment of Receipt of Materials <br /> w PnnledTyped Name Signature Month Day Year <br /> N 34. Transporter Acknowledgment of Receipt of Materials <br /> Z <br /> Prinled+Typed Name Signature Month Day Year <br /> r— <br /> 35. Discrepancy <br /> J <br /> U <br /> a <br /> LL <br /> 0 <br /> W <br /> a 36. Hazardous Waste Report Management Method Codes (i.e. , codes for hazardous waste treatment, disposal, and recycl!ng systems) <br /> z <br /> c� <br /> LU <br /> LU <br /> 0 <br /> EPAForm8700-22A (Rev 12- 17 ) Previous editions are obsolete. DESIGNATED FACILITY TO EPA' s e • MANIFEST SYSTEM <br />