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Please print or type,f Form designed for use on elite(1 -pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UIAFORM HAZARDOUS WASTE MANIFEST 21,Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> 25 Transporter Company Name U.S.EPA ID Number <br /> 26. Transporter Company U.S.1EPA ID Number <br /> 27a 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.10 Number, 28.Containers 29.Total 30 Unit 31.Waste Codes <br /> HM and Packing Grop(if any) No. Type Quantity WI.Nol. <br /> cc <br /> 0 <br /> 32.Special Handling Instructions and Additional Information <br /> cc 33 Transporter Acknowledgment of Receipt of Materials <br /> uJ � <br /> Printed/Typed Name Signature 0 Month' Day Year <br /> r <br /> o <br /> a- <br /> (A 34,Transporter Acknowledgment of Receipt of Materials <br /> Z <br /> Printed/Typed Name' Signature Mgrt <br /> Day Ye <br /> F- <br /> 2 <br /> 35 Discrepancy 1: <br /> LL <br /> LLI <br /> 36 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal and recycling systems) <br /> of <br /> LU <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete, <br /> DESIGNATED FACILITY TO GENERATOR <br />