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Please print or type. Form designed for use on e;;, 12- itch t ewriter. Form Approved,OMB No.2050-0039 <br /> 4 UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Genera'tor's Name <br /> 25. Transporter Company Name U.S.EPA ID Number <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 <br /> HIM and Packing Group(if any)) No. Type Quantity Wt.Nol. 31.Waste Codes <br /> BASIC?.. <br /> ... 31 1r ,,.L.) I j Ur. <br /> r ATEX PAINT.) 3 <br /> 0 <br /> I <br /> z - <br /> c� <br /> ---------- ,--- -- <br /> 9 <br /> ak <br /> t <br /> i <br /> I <br /> 32.Special.Handling Instructions and Additional Information ,a .. <br /> ..._.,,,....,vrrr.y�-.— L.........s�vs 4 L. �f i.4 Q-151 <br /> �7 <br /> Ex 33.Transporter Acknowledgment of Receipt of Materials <br /> F Printed/Typed Name Signature Month Day Year <br /> w <br /> O <br /> a <br /> Z 34.Trans orter Acknowled ment of Receipt of Materials <br /> PrintedlTyped Name Signature Month Day Year <br /> H <br /> } 35.Discrepancy <br /> v <br /> 0 <br /> LU <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> a <br /> Cn <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. 11 1- 7 _.)�_. <br />