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��GQ'OZ3 a <br /> Please print or Form designed for use on elite 12 itch writer. Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking(lumber <br /> (Continuation Sheet) <br /> 24.Generators Name 11 L.J o <br /> rj'- <br /> 25. Transporter Company NaU.S.EPA ID Number <br /> r�� <br /> o —4—i�✓� AA .1, �O A �y <br /> Jri LIa rr`j�15 V -1 <br /> � , <br /> Number 26, Transporter Company NameA ch?t-,/ .�e rrrl e J ��l f�$ T-V U.S.EPA IDumber <br /> je®0 0 0 a 5 d <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)) <br /> No. Type Quantity Wt.Nol. 31.Waste Codes <br /> f <br /> r <br /> i <br /> r <br /> c <br /> r <br /> f <br /> cc i <br /> O i <br /> w <br /> z ' <br /> w <br /> C9 <br /> f <br /> i <br /> 1 <br /> i <br /> i <br /> 32.Special Handling Instructions and Additional information <br /> 33.Transporter ment of R of Materials <br /> LU Prnted/Typed/Name Signature Month Day Year <br /> a L <br /> Z 34.Tra meet of Receipt of Materials on <br /> Q� Printed/Typed eg ature <br /> n ay Year <br /> 11-7 <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> C3 <br /> w <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> Uj <br /> w <br /> n <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />