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Plnom mint nr hmn (P— rineinmrl fnr ..en nn uliln I 19-4'k I 1 <br />EPA Form 8700,22A (Rey, 3-05), Previous editions are obsolete. <br />DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />121. Generalor ID Number <br />GAL000344439.41 <br />22. Page <br />23. Manifest Tracking Number <br />1221539K.E <br />24. Generator's Name <br />25. Transporter --r Company Name U.S. EPA ID Number <br />rl a' i Har RervicesIi: D039 a v [ <br />? <br />6. Transporter .Company Name: � / � U.S.UEPA ID Number <br />27a. <br />HM <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Containers <br />29. Total <br />Quantity <br />30. Unit <br />Wt.1vol. <br />31. Waste Codes <br />No. <br />Type <br />O <br />w <br />O <br />32. Special Handling Instructions and Additional Information <br />33. Transporter Acknowledgment of Receipt of Materials <br />w <br />a <br />PrintedlTyped Name Signal e ' Month Day Year <br />N <br />34. Transporter .L Acknowledgment of Receipt of Materials r --M—onF <br />Printed/Typed Name Signature Day Year <br />O <br />Q36. <br />Z(9 <br />35. Discrepancy <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />asW <br />D <br />EPA Form 8700,22A (Rey, 3-05), Previous editions are obsolete. <br />DESIGNATED FACILITY TO GENERATOR <br />