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Please Print or type. Form desi ned for use on elite 12- itch writer. <br /> Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generaloes Name <br /> U.S.EPA ID Number <br /> 25. Trans rter Company are CC l ' ,l <br /> J O o l C/ (/ <br /> U.S.EPA ID Number <br /> 26. Transporter t___ mpany 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 Group(if any)) No. Type Quantity WtNol. <br /> I <br /> ti I <br /> p <br /> Q <br /> W <br /> z <br /> W <br /> i <br /> i <br /> ' f <br /> i <br /> m <br /> i <br /> i <br /> -t I <br /> I v <br /> �I t <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Tran er <br /> Acknowledgment of Receipt of Materials <br /> LU PrintedrTyped Name r y Signature Month Day Year <br /> 01 <br /> ate. <br /> Z 34.Trans er 9 Ackflowledgmentof Receipt of Materials - " <br /> Pnntedrryped Na Signature Month Day Year <br /> F- �a Z �7 <br /> } 35.Discrepancy <br /> J <br /> U <br /> Q <br /> lL <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatrnenl,disposal,and recycling systems) <br /> Z <br /> C2 <br /> N <br /> W <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />