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'lease print or type Form desi ned for use on elite 12 itch typewriter,) Form Aroved,OMB No.2050-0039 t 22.Pae 23.Manifest Tracking Number <br /> A N!FORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number g <br /> (Continuation Sheet) <br /> 24,Generator's Name <br /> U.S.EPA ID Number <br /> 25. TransporterCompany Name <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> No. <br /> Type Quantity Wt.Nol. <br /> HM o and Packing Group(if any)) y <br /> ff <br /> W <br /> Z <br /> LU <br /> d <br /> I <br /> r ....W.._.-, <br /> r 7 it iti! 'CHf-49.1 t <br /> T- <br /> 32.3 1 pecial Handling Instructions and Additional Information <br /> 33.Transporter Acknowled ment of Recei t of Materials Signature Month Day Year <br /> W PrintedtTyped Name <br /> O <br /> CL <br /> Z 34.Transporter Acknowled ment of Receipt of Materials Signature Month Day Year <br /> Q< Printed/Typed Name <br /> F- <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> O <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 /> O • <br /> N <br /> W <br /> iD2viGjNj d=�D F,�CI 1T'.'TO G1'1ZRXTOR <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br />