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Please print or type. (Form designed for use on elite 12 itch) typewriter.) Form Approved. OMB No. 2050039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121 , Generator ID Number 22. Page 23. Manifest Tracking Number <br /> (Continuation Sheet) CA L O L133 "l ? ( ® � 2L Y 27 Y / � � �� <br /> 24 . Generator's Name C <br /> i/ /Z r C <br /> U.S. EPA ID Number <br /> 25. Transporter Company Name <br /> 26. Transporter Company Name U.S. EPA ID Number <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 Wt.Nol. <br /> rML1 <br /> s , <br /> Uj <br /> i <br /> t <br /> S <br /> P <br /> i <br /> t f <br /> 0 <br /> t <br /> t <br /> 1 <br /> 32. Sgecial Handling Instructions and Additional Informal' <br /> fp, 'V4L 5 r-} S �(o Y-FS.j' ) <br /> 33. Trans iter Acknovded ment of Receipt of Materials <br /> LU Printed/Typed Name Signature Month Day Year <br /> t— <br /> O <br /> M <br /> 34. Trans iter Acknowledgment of Reoei t of Materials <br /> Printed/Typed Name Signa ure on ay ear <br /> F- <br /> 35. Discrepancy <br /> _J <br /> U <br /> L <br /> O <br /> i 36. Hazardous Waste Report Management Method Codes (Le', codes for hazardous waste treatment, disposal, and recycling systems) . <br /> O <br /> in <br /> w <br /> 0 <br /> EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />