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Please dnt or ty a. Form designed for use on elite 12- itch writer. Form Uproved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 . Generator ID Number 22. Page 23. Manifest Tracking Number <br /> (Continuation Sheet) �7 'Pe � 8 9902 c� °� w <br /> 24. Generators Name O /s jo <br /> 'I 4j gv <br /> U.S. EPA ID Number c <br /> 25. Transporter Company Name <br /> J EPA ID Number <br /> 26. Transporter Company 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 WL/Voll <br /> O <br /> W <br /> 32, Special Handling Instructions and Additional information <br /> 33, TAdvw mento of Materials <br /> 1W-- Pdntedffyped Name Sg MonSh Day year <br /> X, <br /> (J <br /> O <br /> Q, <br /> z 34. T ment of RoW t of Materials <br /> PrintedfTyped Name Month Day rear <br /> F <br /> 35. Discrepancy <br /> _J <br /> V <br /> r41. <br /> C <br /> tR36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> z <br /> W <br /> A <br /> EPA Form 8700.22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />