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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.General U Number r /i 22.P e 23.Manifestrac�9ums Nber <br /> (Continuation Sheet} ZA <br /> ' `5' /LJ <br /> 24.Generators Name <br /> 25. Transporter Company Name a U.S.EPpVmbgr' <br /> 2= 1107 <br /> 26. Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(induding Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity VVLNd. <br /> 1 <br /> O <br /> Lu <br /> z <br /> c� <br /> 32.Special Handling Instructions and Additional Information <br /> cr 33.TMSWWF--1��menlV Recei of Materials <br /> LU Prinw I yped <br /> e6j <br /> Si9"rA� or�lq Day Y-57 <br /> a {/yf <br /> z 34,Transporter Aduiowledgment of Receipt of Materials <br /> NntedlTyped Name Sig re Month Day Year <br /> 35.Discrepancy <br /> J <br /> U <br /> is <br /> O <br /> LU <br /> 36.Hazardous Waste Report Management Metlrod Codes(i.e.,codes for hazardous waste treatrnent,disposal,and mcyding systems) <br /> z <br /> cti <br /> rA <br /> 1L <br /> D ' <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO EPA's e-MANIFEST SYSTEM <br />