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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.GeneratorlDNufnber �1�} 22.Page 23Mfest Tracking Number -' <br /> (Continuation Sheet) � � 7 »` / ! _9 ./ <br /> 24.Generator's Name LJ 0 r (, r'a S <7 r4d�D 6 4= L,L-C 0 0 VTr'�'�✓ <br /> 25. Transporter T Company NameU.S.EPA QNumber <br /> 26. Transporter ) Company Name U.S.EPA ID Number <br /> 27a. 27b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantify M./Vol. <br /> I <br /> o , <br /> z <br /> >L <br /> 32 Special Handling Instructions and Additional Information <br /> f F r=LL.,P?0 /,v blxk <br /> i Jr� r Cc�r�s� �C L�01 . <br /> Ix 33.Transporter Acknowledgment of Receipt of Materials <br /> uLr PrintedrTyped Name Signature Month Day Year <br /> aJ n ? 4- 7 ✓sem' C,' J', <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> Pdnted[Typed Name Signature ;; i Month Day Year <br /> 35.Discrepancy <br /> i <br /> J_ <br /> to <br /> a <br /> 0 <br /> u, <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> 0 <br /> W <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />