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Please print or type, Form designed for use on elite 12- itch t ewriter. Form Approved , OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121P Generator ID Number 22. Page 23, Manifest Tracking Number <br /> (Continuation Sheet) L. ® ®0 Ll �� y � i' ® � � ® (V �- � <br /> 24, Generator's Name <br /> Age at I CAOJ �z3 Cy <br /> U.S. EPA ID Number <br /> 25, Transporter Company Name <br /> U.S. EPA ID Number <br /> 26, Transporter Company Name <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 any)) No. Type Quantity wtivol. <br /> WAOSTC WASPcKAvet oN l VuA st; Llcl b i <br /> Aw <br /> I <br /> C <br /> R /Los IUAE /Vos, 3 (G . c L/ tct� <br /> ® Ula! 2, 72 .0 WA-S Co44LCSI uje Lt05 � <br /> y ® �oC14UH, tClir, <br /> LU <br /> te) ( I (= 1 a <br /> LU � J� Z��j L/c�tAIS 4 / <br /> t <br /> ..V q <br /> I <br /> /CAI �w <br /> t ; tm4PtOKt b12./ AZ !IW 1405, &Rata l vt t <br /> O#V® S' t ) � LE(PkSPAOM6t_a&A ,tor <br /> 32. Special Nandlin Instructions an Additional loform t n P �� �CL— D7 I V S 1 `Z SoLk 5 L/ p ) <br /> /� � / c� 5��,^® � C / }C � CIA *rlL- Opw C/ �( za C> K ( Dt (,oi,a. c.//2 VCL^ lz <br /> gt -o C'Ixzip ) Pr � ® u �xtLL1 � s� P/3 Gx <br /> 7 ttrc , Ccr <br /> 33. Transporter Acknowledgment of Receipt of Materials <br /> LLI <br /> PdntedfTyped Name Signature Month Day Year <br /> O <br /> n. <br /> XTransDorter . Acknowled ment of Recei t of Materials <br /> Printed/Typed Name Signature onth Day Year <br /> H <br /> 35. Discrepancy <br /> r <br /> V <br /> uQ.. <br /> LU 36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> O <br /> L <br /> LU <br /> 0 <br /> DESIGNATED FACILI T Y TO DESTINATION ATE (IF REQUIRED) <br /> EPA Form 8700-22A (Rev. 3 05) Previous editions are obsolete. <br />