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,4 <br /> t t r <br /> Farm Approved.OMB No,20SM039 <br /> Please print or type.(Form designed for use on elite(12 itch)typewrltef.) 22 Page [2-37M—.n1fest Tracking Number <br /> UNIFORM HAZARDOUS WASTE MANIFEST 2 .Generator ID Number <br /> ✓' <br /> (Continuation Sheet) <br /> 24.Generators Name <br /> U.S.EPA ID Number <br /> 25. Transporter Company Name t" <br /> U.S EPA ID Number <br /> 26. Transporter Company Name <br /> 28.Containers 2g.Total 30.Unit 31,Warms Codes <br /> 27e. 27b.U.S.DOT Description(Including Proper Sf+i es <br /> ing Name.Hazard Clam,ID Number, NoType Quantity WtNol. <br /> HM and Packing .ng Group(if any)) t <br /> i <br /> R <br /> O <br /> W <br /> 32,Special Hartdgng instrudbns and Additional infof natioa <br /> f,d t,.`'•y'41$;k <br /> 33.Transporter —Acknowledgment of Receipt of Materials <br /> H Phriled/Typed Name S*neture Month Day Year <br /> 34 Transporter Acknowied nt of R11,pt of Metsrials <br /> Printed/Typed Name Signature Month Day Year <br /> Y 35.Discrepancy <br /> J l <br /> V <br /> D <br /> 36.Hazardous Waste Report Management Methodes(i.e.,Codes for hazardous waste treatmeo,disposal,am recycling systems) <br /> W <br /> G <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />