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Please print or type-(Form cipsirgned for use on elite 12-pitch)typewriter,) Form Approvedl,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Ganerato.,IDNumber ) 22.Ps 23.Manifest'7racking Number <br /> (Continuation Sheet) <br /> 24 Generators Name <br /> j <br /> 25 Transporter I_ Company Naar U S.EPA ID Number <br /> 26 T,,amport,t� G J-S.EP„1D ldu nL; � <br /> v fy)no i i o j <br /> 28.Container 31..J,:sle Cod <br /> 21a 27b.U S DGi De=,r;ri;➢Rao,�(lnr�uding f"cty7er Sh'ip`sin+U Name.Naxant Maass.ID Nrt,r�ber 2�.Total 30.Unit 'r_ <br /> HM and Packing Group(if any)) ,No, Type Quantity Wt.Nol. <br /> f' <br /> 0 <br /> UA <br /> I , <br /> , <br /> -32.Special Handling Instructions and Additional intormavon <br /> 33.Trarsoorter ,,_Lt Acknowledgment of Rece:o'of Materials <br /> LLJ P'rn!eed Name Signature Month Jay Year <br /> .Transpor9 At nowicdgantni tf ec iyt of Materials <br /> . tryped dr<9 ILL <br /> 3,911 Discrepancy <br /> i-- <br /> .:.r <br /> c.! <br /> 4 <br /> aa. <br /> w <br /> 4 36,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Treatment,disposal,ar^d recycling systems) <br /> Z d , <br /> v� <br /> LU <br /> L] <br /> EPA Form 8700-22A(Rev.3-05; Previous editions are obsolete. DESIGNATED FACILITY Y TO DESTINATION STATE(IF REQUIRED) <br />