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Please print or type. Form designed for use on elite 92- itch ewriter. Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 a for ID 22,Pae 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24,Generators Name <br /> 25. Transporter Company Name �1n` , U.S.EPA ID Number <br /> l" 5 L c ,r r o ate✓ L't'e rJ,f t mo 2) L) - a 3& F <br /> 26. nspo er C anyN e � � w � `� <br /> U.S.EPA ID Number <br /> V ` aL- <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if ary)) <br /> No. Type Quantity wt./Vol. <br /> aO <br /> EY <br /> W <br /> Z <br /> LU <br /> C7 <br /> 1 <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter 77� Acknowleclment of Receipt of Materials <br /> Lu TsPrinted/Typed Name Signatu Month Day Year <br /> Z 34.Trans der Acknowledgment of Recei t of Materials <br /> Printed yped Name s natu <br /> � r on Year <br /> 35.Discrepan <br /> J <br /> U <br /> a <br /> 0 <br /> LU <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> O <br /> w <br /> v <br /> EPA Form 8700.22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />