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Please print or type. Form designed for use on elite 12 itch typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> ( U.S.EPA ID Number <br /> 25. Transporter Company 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 /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol, <br /> JA <br /> � — I <br /> z I I <br /> w jc7 <br /> i <br /> 32 Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> N Printed/Typed Name Signature Month Day Year <br /> O <br /> z 34.Transporter Acknowled ment of Receipt of Materials <br /> PrintedlTyped Name Signature Month Day Year <br /> 1-- <br /> } 35.Discrepancy <br /> J <br /> U <br /> a <br /> LL <br /> 0 <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 /> C� <br /> L <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. I"y 1',j 7 I:.'C 1 1711• <br />