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i <br />Please print or type. Form designed for use on elite 12 itch typewriter.) <br />Fnrm Annrnvari nmR wn 9n5n-nnAo <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />21. Generator ID Number - <br />22. Page <br />23. Manifest Tracking Number <br />(Continuation Sheet) <br />24. Generator's Name <br />25. TransporterU.S. EPAID Number <br />Transporter Company Name , , ; I <br />i r <br />26. Transporter Company Name U.S. EPA ID Number <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 />HM <br />and Packing Group (if any)) <br />Quantity <br />Wtivol. <br />31, Waste Codes <br />No. <br />Type <br />O <br />w <br />Z <br />w <br />c7 <br />5 <br />I <br />1 <br />l <br />32. Special Handling Instructions and Additional Information <br />33. Trans nen Acknovded ment of Reoei t of Materials <br />W <br />Printedfryped Name Signature Month Day Year <br />a <br />z <br />34. Transporter Acknowledgment of Receipt of Materials <br />Panted/Typed Name Signature Month Day Year <br />F— <br />35. Discrepancy <br />O <br />W <br />Q <br />36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />Z <br />rn <br />W <br />>PA <br />Form 8700.22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />