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Please not or "e Form Desi"nedfor us 'cti elife't2=ttcft ewntet -Form Approved.OMB No,:2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator ID Number - 22.Fag 23,Manifest Tracking Number <br /> (Continuation Sheet) 93 2-c? 7 ° o 6106�� I <br /> 24.Generator's Name <br /> U.S. <br /> U.S.EPA ID U.S. <br /> PA ID Number II <br /> 25.Transporter Company Name - }- ( � <br /> 26. Transporter Compa a e l 1 <br /> A,vl ` �� �kmen P .�ervi c r�1 C3 I? <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 21.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity wt./Val. <br /> I <br /> LU <br /> i <br /> i <br /> I <br /> { <br /> F _ <br /> 32 Special Handling Instructions and Additioral Information <br /> i <br /> 33.Trans orter Acknowled ment of Rece pt of Materials <br /> LU Printed/Typed Nam6 signature Month D yg <br /> p <br /> a _ <br /> Z 34.Transporter Acknowledgment of Receipt of Mate_r als <br /> Printed/Typed Na a gnature w Mz ------=anth Y Year <br /> 35,Discrepancy Lj <br /> J <br /> U <br /> fl <br /> LU <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,dispoiai,and recycling systems) <br /> Uj <br /> w <br /> EPA Form 8700-22A(Rev.3-05) Previous e6tioos are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />