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7717 <br /> Please print or type. Form designed for use on elite 12- itcr ewriter. <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator ID Number22.Page 23.Manifest Tracking NumberorM <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./Vol. <br /> �`11 StF�� f•y�-.F t f rC I T�'../I•� .� �� <br /> ��� __.___.�.. _., ....._.. ... <br /> V <br /> LthiJ tT'9 WP$STE CnIiS1c7.1I.i OL I N Ur `_:,. <br /> 1111 HYPI iCHLGR;:Ti—;'}, <C{t"}j r j� E.'FlG# <br /> �VI Nu OP) <br /> ING LIQUID, -110 D- <br /> O rrf 5 9 y V.H:' ROGEiERC!.,IGF,' y (DO )s ERG#i�.{; <br /> W i F !f`, I G?I..F d U,t', 0IF"6fahF 14, -ta <br /> s �c 4—DICHLCJ�?i�F` #,± `-;9't�t ET LC <br /> Tc. ,F:+V�tt{ � , .•irr -F, :.i17 <br /> ^: „'+ -�Y.`+. '",, 7 '�� '- i'( rr,;q, 'tr;?� <br /> ���+ / TT_rf <br /> H �T.r. ._i y l F, �: <br /> .�Fv ci <br /> P—r <br /> v'?C I Y i_a -P—nI F, <br /> ,r ` sats � l { i {Ckrr ;r:f �F3 —' ";� <br /> �Fy(1 � r `�S f yr t1a 1 p � t "Y f a�1! 4 _ LL..� <br /> r t 1 1�4 <br /> 32.Special Handling Instructions and Additional Information � �; — ,A Fc} >. 1 � A u 2 F J F S r L=s h' <br /> 33.Transporter_Acknowledgment of Receipt of Materials <br /> W Printed(Typed Name Signature Month Day Year <br /> F— <br /> O <br /> n <br /> cl)Z 34.Transporter Acknowled ment of Receipt of Materials <br /> G Printed(Typed Name Signature Month Day Year <br /> t•— <br /> r 35.Discrepancy <br /> s-- <br /> J <br /> LL <br /> O <br /> Q36.Hazardous Waste Report ty'anagement Method Codes(i.e.,codes for hazardous waste treatment.disposal..and recycling systems) <br /> 0 <br /> LJ <br /> 0 <br /> `.I� `,��r,`+�L.Cf�I�Y-0 rt !?MRrt',i ; <br /> EPA Form 8706-22A(Rev.3-05) Previous editions are obsolete. <br />