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Please print or type. Form designed for use on elite(12-pitch) writer-)eForm roved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.P 23.M nlfest Tr eking Number / <br /> (Continuation Sheet) + )1 2 { <br /> 24.Generators Name <br /> U.S.EP tD N mb:• <br /> 25. T ansporter Company Name O <br /> U.S.EPA ID Number <br /> 26, Transporter Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Shippng Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Paddng Group(if any)) No. Type Quantity WtIvol. <br /> O <br /> w <br /> Z <br /> w <br /> C7 <br /> I <br /> I <br /> 32.Special Handling Instructions and Additional Information <br /> 33 Trans er ment of Receipt of Ma.enals Si ure Month Day Year <br /> H PrintedrTyped Name <br /> O ' <br /> IL <br /> Z 34.Transporter Acknowledgment of Receipt of Materials Signature Month <br /> ay Year <br /> Pdrited/Typed Name <br /> r <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> O <br /> Q36.Hazardous Waste Report Management Method Codes(ie.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> c� <br /> w <br /> 0 <br /> EPA Form 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />