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Please Print or Npe. Form designed for use on eliteMr <br /> ewriter. Form A roved.OMB No.2050-00: <br /> UNIFORM HAZARDOUS WASTE MANIFEST ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> U.S.EPA ID Number <br /> 25. Transporter Company Name <br /> 1.. 1 <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> 27a, 27b US DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28,Containers 29.Total 30.UnR 31.Waste Codes <br /> HM and Packing Gnwp H anY)) Nq ,..�.: Ty.: .. �IaMi1X <br /> i <br /> ! 1 <br /> 1 <br /> I <br /> 1 l <br /> JXO <br /> r <br /> W <br /> Z 4 : <br /> W I <br /> (.0 a I <br /> 1 <br /> 1 <br /> t <br /> i 1 <br /> i <br /> ! I <br /> i <br /> l 1 <br /> i 1 <br /> 1 <br /> I <br /> I I <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> W Pnnte&7ypedName Signature Month Dayl Yea <br /> a <br /> z 34.Transporter !ZgoMed ment of Recei 1.of Materials, —Signaturey e, <br /> Drinted: yped Name ........-... month <br /> H <br /> 35.Discrepancy <br /> U <br /> LL <br /> Q =Hazardousste Report Management Method Codes(i a.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> W <br /> EPA Form 6700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATI <br />