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Please print or type. Form Approved,OMB Na.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121,Generator ID Number 22..Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24,Generator's Name <br /> 25. Transporter Company Name, <br /> U.S.EPA iD Number <br /> 26. Transporter Company Name U.S.EPA I Number <br /> 27a. 27b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers <br /> P { 9 P PP 9 29.Total 30,Unit 31._Waste.Codes - <br /> --HM ;end-Packing-Group-{iP-any)) -- — -- — --- —.—._ --No. Ty - -Quanfiy Wt7Vo€ <br /> F- <br /> ur <br /> z . <br /> w - <br /> 0 <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> F PrintedlTyped Name Signature Month Day Year <br /> O <br /> r1 <br /> Z <br /> 34.Transporter Acknowledgment of Receipt of Materials <br /> PrinfedlTyped Name Signature Month Day Year <br /> t` <br /> 35.Discrepancy <br /> F <br /> J_ <br /> a <br /> Q <br /> Lo <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> LD <br /> to <br /> EPA Form 8740-22A(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />