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Please vhnt or type. Form designed for use on elite 12-pitch)typewriter.) Form AppMved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Paye 23.Manifest Tracking Number <br /> (Continuation Sheet) L L C— <br /> 24,Generators Name <br /> 7) C, <br /> 25. Transportar _57 Company Name U.S.EPA ID Number <br /> ld� � � SoU�t l �d1 &L 12 000oc' <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 Getup(it arty)) No. Type Quantity WINoL <br /> E <br /> i <br /> r <br /> r <br /> 1 <br /> I <br /> �t <br /> ——— --—�w---_ <br /> w <br /> UA <br /> I <br /> i <br /> r <br /> i <br /> E <br /> I <br /> I <br /> +i+ <br /> I <br /> 32.Special Handling instructions and Additional Information <br /> 33.Trans ortec AcWaMedgiment of Rece t of Materials S re Month pay Year <br /> Lu Printed/Typed Name <br /> OX <br /> 17 <br /> LL , <br /> 34.Trans rter A",l ment oI Remi t of Materials <br /> NnlecHyped Name Signature Month Oay Year <br /> 35.Discrepancy <br /> J_ <br /> U <br /> a <br /> LL <br /> a36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.disposal,and recycling systems) <br /> Z <br /> 0 <br /> w <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />