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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Ge o ator ID u r 22.PCe ? Ma test Tracking�ber <br /> (Continuation Sheen <br /> 24.Generators Name <br /> +` <br /> V� <br /> 25.Transporter CompanyName"�.- U.S.EPAID Number <br /> --Ir; Safe r �r,Ns�� 0 D 69FYJ7 <br /> 26.Transporter Company Name U. EP ID Number <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 /> K <br /> O <br /> W <br /> Z <br /> W <br /> C9 <br /> 32.Special Handling Instructions and Additional Information <br /> 4, 33.Trans r Admowled ment of Receipt of Materials <br /> Printedrryped (t ( C Signal re Month Day Year <br /> O PdY1 I T <br /> a <br /> z 34.Transporter <br /> —_S4Acknowledgnjent of Receip of Materials <br /> PrintedfFyped N me Signature Month- Day Yea <br /> 11 <br /> 35,Discrepancy S <br /> J <br /> U <br /> Q <br /> LL <br /> 0 <br /> LU 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> 0 <br /> y <br /> w <br /> 0 <br /> EPA Form 8700-22A(Rev.12.17)Previous editions are obsolete. DESIGNATED FACILITYTO EPA's e-MANIFEST SYSTEM <br />