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PIon ca mint nr tuna IPnrm rincinnad fnr -in nn alita II 9_nitr•hI hmaurrilar 1 <br />C....., A............1 ARM \l.. —CA An- <br />EPA Form 8700,22A (Rev, 3-05),.Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />Generator ID Number <br />22. Page <br />-- ---- ---- <br />23. Manifest Tracking Number <br />(Continuation Sheet) <br />121. <br />; ° 4 ;I t ' (::j <br />i <br />24. Generator's Name <br />25. Transporter _ Company Name U.S. EPA ID Number <br />- <br />Cloan <br />% l ' U.S. EPA ID Number <br />26. Transporter Company Name. / j f,, :71,/� �`'` e •- <br />27a. <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />28. Containers <br />29. Total <br />30. Unit <br />31. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wl.Nol. <br />a <br />W <br />t:7 <br />------------- <br />32. Special Handling Instructions and Additional Information <br />33. Trans der Acknowledgment of Receipt of Materials <br />H <br />Printed7Typed Name Signa Month Day Year <br />a <br />iJi2ti:it?li P t' '!.t' 1'} �) { f <br />34. Transporter ' Acknowledgment of Receipt of Materials <br />PdntedITyped Name }. ! Signature on ay ear <br />J <br />35. Discrepancy — <br />v <br />Q <br />u. <br />Q36. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />(9 <br />W <br />O <br />EPA Form 8700,22A (Rev, 3-05),.Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />