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Please print or typo. Form designed for use on elite(12-pitch) ewriler. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121-GLneratorlDNumbeT22.Page 23.tdanlfestTracking Number <br /> (Continuation Shoot) C A fL <br /> 24.Gonerators Name <br /> US.EPA ID Number <br /> 25,TransporterCompany Name <br /> \ Tl <br /> U.S E AlD Number <br /> g6.Transporter CompanyNamo J/� �j'n <br /> 27a, 27b.US,DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 28 Containers 29 Total 30 Urtt 31.Waste Codes <br /> HM and Packing Group(if any)) tJo. Type Quantity "JVot. <br /> r <br /> a <br /> a <br /> w <br /> z /w <br /> 0 <br /> I <br /> 32.Special Handl;ng instructions and Additional InformaWn <br /> a 33.Transporter Acknoai d mont of Recec t of Mateials <br /> hPrinlc67ypedNamo t, <br /> Signature Month Day Year <br /> ti <br /> 0 i <br /> a <br /> z 34.Trans rfer__ A nowtednimeril of Receipt of Malen<s <br /> Pnnted/TypedIr <br /> Signature ootYear <br /> r— <br /> 35.Discrepancy <br /> J <br /> Ed <br /> U <br /> Q <br /> LL <br /> Ed <br /> 36,Hazardous Waste Report Management Method Codes(r e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> L9 <br /> Ilk, <br /> ger <br /> C:) <br /> EPA Form 8700.22A(Rev 3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />