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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> UNIFORM HAZARDOUS WASTE MANIFEST Form Approved.OMB No.2050.0039 <br /> 21.Generator 1D Number / �22.. a 23.Manires Tr kin9 Number(Continuation Sheet)24.Generators Name G <br /> 15.Transporter_ Company Name U.S.EPA 10 Number <br /> u � f{p9/�/�r�/�,�zz- <br /> 26.Transporter_ Company Name LQ„ �_}_r Q ' /0`/ ��`�s 1 V60 <br /> 27a. 27b.U.S.OOT Description(including Proper Shipping Name,Hazard Class,10 Number, 28.Containers <br /> HIM and parking Group(ir any)) 29.Total 30,Unit 31.Waste Codes <br /> No. Type Quantity W11V01. <br /> !t I <br /> Ino <br /> l I <br /> z <br /> W <br /> I <br /> J2.Special Har>drmg Instructlo ns and Additional Information <br /> 33.Transporter vledgment of Receipt of Materials <br /> Lu Pninledfryped N me � $' �` A�h Day year <br /> 0 r� 1 6 <br /> 0 <br /> a <br /> Z 34.Transporter______Adurowledgmemt of Receipt of Materials <br /> Pmwdrryped Name Signature t <br /> 35.Discrepancy <br /> v..r <br /> v <br /> w <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.disposal,and recycling systems) <br /> 0 <br /> CO <br /> LU <br /> v <br /> EPA Form 8700.22A(Rev.3.05) Previous editions are obsolete. 71_SIGMATECFACILITY TODCSTH,KT,IOMSTATE(IF;;�:�ul�r_n; <br />