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Please print or type. Form designed fcr use on elite 12- itch typewriter.) Form Approved.OMB No.2050-0039 <br /> 0,1117GR.0 HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22 Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> 25. Transporter Company Name <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> 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 <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 31.Waste Codes <br /> SH <br /> _ _ 2i. <br /> 17 C...mo i. � i' E7ii.iLEJt! ID.iS 1Li..�.1+,J 1 , +.LSI+ ,.I ERU# <br /> Ytl, <br /> .?a�J: �V:fS`E FLAMMABLE SOLIDS, ORGANIC, w <br /> t r T f PI77rT'Q1 Ell rx rcr P-1 q. n <br /> O PC- `,1141-177'4, JAST fj",I✓i^111x, `EQ L.I Uq X Q. a. <br /> a lj t.,GT7; t z,, G1 HLOk��',= , 5-DI .ETHILR1trANT IN <br /> z <br /> w <br /> c7W3 9, WASTE QXfrolZING LIQUID", N 0. S. +1 t <br /> a , T fi'nt t303F1i 'FEROXIDE.i 1341 At_+ <br /> A X r,'Q <br /> ORGANIC' <br /> RIQ, U.42119 z t, WASTE TT C SOLIDS, ORGANI', 0, <br /> C w - F T l a ♦Ks t <br /> N a <br /> P.1 <br /> Ir r^r^ <br /> DF <br /> � t <br /> 6n4 y : 01 <br /> 442' 4 SATTE'^'TES� WET, FILLED IWITVAGID��-*-- <br /> 1.'ra :�t `8, EAT"TIES, DRY, CrJkdTAINI"!u <br /> HYDROXIDE t?i2OXIDE SG3LT,',, 8, PGIII, ;UNIVERSAL <br /> T <br /> 32 Special Handling Instructions and Additional Informatio <br /> J LDR -, .' ?_.La'SL�$x a 1� i 1 a3I31 H Li Z J " <br /> W5 jf.0921-9 L ER Is., `W1 r 0715132 '.DR' 1�. 415�.SiSiE^, � . " � � 14. 710�'i.�09 14 <br /> 33.Transporter-Acknowledgment of Receipt of Materials <br /> W Printed/Typed Name Signature Month Day Year <br /> O <br /> a <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> H <br /> 35,Discrepancy <br /> H <br /> _J <br /> V <br /> Q <br /> LL <br /> LU <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 /> C7 " <br /> U) <br /> LU <br /> O <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIG?i-!=D FACILITY TO GENERATOR <br />