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P1.... —W — h— Xnl— door—,4 -I;#- No ... ..... :1— 1 <br />EPA Form 8700,22A.(Rey.,3- <br />,P5)Previous editions are obsolete. <br />DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST 21. Generator ID Number22. <br />. Page <br />r -U1111 MPPIUVt:U. UVAD No. ZU0U-UU&1 <br />23 Manifest Tricking Number <br />(Continuation Sheet) <br />'244 <br />24. Generators Name <br />25. Transporter Lmpany Name <br />U.S. EPA ID Number <br />26. TrapsporterCompany Name <br />ID Number <br />27a. <br />27b. U.S. DOT Description (including Proper Shipli)ng Nam, Hazard Class, ID Number, <br />28. Containers <br />29. Total <br />30. Unit <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt./Vol, <br />31. Waste Codes <br />No. <br />Type <br />0 <br />Z <br />LU <br />V <br />— - - - - - — - - - - <br />32. Special Handling Instructions and Additional Information <br />33. Transporter Acknowledgment of Receipt of Materials <br />LU <br />'dName <br />PrintedfType <br />Signature <br />Mjrlth Day_ Year <br />yr <br />Z <br />34, Transporter A&iowledgment of Receipt of Materials <br />Prinledrryipe� Nahle <br />6 <br />Signature <br />Month Day Year <br />35. Discrepancy <br />:3 <br />L<1 <br />LU <br />36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />rn <br />EPA Form 8700,22A.(Rey.,3- <br />,P5)Previous editions are obsolete. <br />DESIGNATED FACILITY TO GENERATOR <br />