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Please print or type. Form Approved.OMB No.20-%-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator ID Number 22.Page 23.Manifest Tracking Number r/ <br /> (Continuation Sheet) Uq bot--4-x-1'63 t y iS <br /> 24.Generators Name <br /> 25. Transporter CompanyNama � rT�S� ` [L U.S.EP,�/hC <br /> IDlNumber b���� <br /> 26. Transporter Company Name - W, U.S. PA N her <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 31.Waste Codes <br /> O <br /> t•— <br /> W <br /> Z <br /> 32.Special Handling Instructions and Additional Infannabon <br /> 33.T rment of Receipt of Malenais <br /> W Printed/Typed Name +I` s <br /> " <br /> fnature Moth nDay Year <br /> O <br /> a <br /> U) 34.Tramporter Acknowledgment of Receipt of Materials <br /> Prmted/Typed Na Signafu Year <br /> a- Aga;!� zam&� AH <br />. 35.Discrepancy <br /> 7 <br /> Lt <br /> a <br /> LL <br /> 0 <br /> a36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> c7 <br /> uU <br /> W <br /> O <br /> EPA Form 8700-22A(Rev.12-17) Previous editionsare obsolete. DESIGNATED FACILITY TO EPA's e-NIAVIFEST SYSTEM <br />