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Please print or type, Forth Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 12';'G- or ICT, umb r� � "' �F" 22_P h 23.ManifestTrackingNumber <br /> Continuation Sheet <br /> tf <br /> 24.Generalor's Name ' <br /> 25.Transporter Company Name U}S:EJhlp N6m/ber <br /> 28.Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b-U-S.DOT Description(including Proper Shipping Name,Hazard Class,JD Number, 28.Containers <br /> P ( 9 P Pp 9 29.Total 30.Unit No. 31.Waste Codes <br /> HM and Packing Group.(i€.any)).. -....-.__ ._.. __.,.,Quantity,..- WC:1Val.,. . , <br /> O € <br /> w <br /> Z <br /> 32.Special Handling Instructions and Additional information <br /> 33.Transporter Acknowledgment of Receipt of Materials 1q f-- <br /> LU Printedrryped Name Signature Month Day Year <br /> co 34-Transporter AcknOwledgmen#of Receipt of Materials <br /> PrfntedlFypad Name Signature Month Day Year <br /> 35.Discrepancy <br /> F <br /> J_ <br /> Q <br /> a <br /> 0 <br /> w <br /> 31j.HaZafd0U5 Waste Report Management Method Godes(J.e.,-0OdeS for hazardous waste treatment,tli5pO5ai;and recycling systems} <br /> Z <br /> 0 <br /> 03 <br /> lL <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />