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Form A roved.OMD No,2050-0039 <br /> Please rint or t e. Form desi ned for use on elite 12• Itch ewriter. 22 Pae 23:MenifestTracking Number <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21•GeneralordD Number <br /> (Continuation Sheet) L-Qf)b 1 <br /> 24.Generator's Name <br /> EPA ICD�Number <br /> 25 Transporter Company NamerSi' thYgy�w�Wl EPAIDNumber <br /> 26,Transporter Company Name Lam! <br /> 28,Containers 29,Total 30,Unit 31.Waste Codes <br /> 278, 27b.U.S.OOT Description(Including Proper Shipping Name,Hazard class,ID Number, No. Type quantity WI.Nol. <br /> Hh{ and Packing Group(If any)} <br /> 0Uj <br /> 1 I <br /> d <br /> W ` <br /> 1�. <br /> 32,Special Handling Insbuclions and Additional Information <br /> %jenih Day Year <br /> 33.Trans oder Acknovrled lot ofh;atedals Signature / <br /> PrintediTyName <br /> Chi G./ A <br /> O . tvlenlh Oay Year <br /> CL gna ure 1 <br /> z 3h Trans rter Acknowled mentofRscel 1ofMaterials �1---- <br /> Prinledrryped Name <br /> 35,Discrepancy <br /> ziU <br /> w <br /> ra <br /> L11 36.Hazardous Waste Report Management Method Codes(i.e.,codes ror hazardous ivaste treatment,disposal,and recycUng systems) <br /> w DSIGNALED FACILITY TO I]ESTINATION STATE OF RFQUIt' <br /> C� <br /> EPA Form 8700-22A(Rev.3.05) Previous edllions are obsolete, <br />