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Please print or Form designed for use on elite 12-pitch) writer. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST ret ID m r , " :[;2,2.Pae 23 Tracgyarwer_, <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> Cr V& l <br /> U.S.EPA tD Number <br /> 25. Transporter Company Name <br /> 26. TwPorter pany N e U.S.EPA ID Number <br /> Co <br /> G c a 67 21-2 O <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Und 31.Waste Codes <br /> HM and Packing Group(if any}) No. Type Quantity Wt.NoI. <br /> O <br /> w <br /> z <br /> w <br /> C9 <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Tran ment cif Receipt of Materials <br /> LU I.- <br /> Printed)) Signature Month Day Year <br /> �l� <br /> a <br /> Z 34.Transporter AcknoWedgment of Receipt of Materials <br /> Pdrtedrryped Name Signature Month bay­-7ear <br /> F <br /> 35.Discrepancy <br /> J <br /> U <br /> a <br /> a <br /> a36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyciing systems) <br /> Z <br /> tJ <br /> Cn <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />