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Please print or type. Form designed for use on elite 12 itchtypewriter.) 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.Generators Name <br /> III I <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 /> � 1 <br /> g <br /> t <br /> + L SIOLG <br /> -21 <br /> 32.Special Handling Instructions and Additional Information 9 <br /> > ,_,.,,:._....�—�,.'r;d�:,-7-'1+�- •�•� I;.d -- - =j w' •4,r•$'j.» ,tie ,-..:r+ <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> F 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 /> } 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <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 /> y <br /> W <br /> D <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY Tr- <br />