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Please p I rint ort e.(Form designed for use on elite typewriter.) Form Approved,OMB No.2050-0039 <br /> UN)FORM'HAZARDOUS WASTE MANIFEST rrator ID Number <br /> :1: .Manifest Tracking 22.Page �23Number <br /> (Continuation Sheet) t4 I <br /> 6,11 <br /> 24.Generator's Name <br /> �j <br /> 21. Transporter- Company Name U.S.EPA ID Number <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 /> HM I and Packing Group(if any)) 31.Waste Codes <br /> 4 No. Type Quantity Quantity Wt.Nol. <br /> OF 3'31 <br /> A A 0 U 71 <br /> 0 <br /> 32.SRcial Handling Instructions and Additiona"Iformation <br /> 2 SS <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> UJI <br /> Printed Typed Name <br /> Signature Month Day Year <br /> 0 <br /> A <br /> co 34.Transporter <br /> Z Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature <br /> Month Day Year <br /> 35.Discrepancy <br /> LU <br /> 36.Haza Waste ranagement Methl rdes odes for hazatdous waste treatment,disposal, <br /> Z <br /> W A m T' <br /> W <br /> EPA Fq 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />