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-Pleaserint or e. Form desi ned Far use nn elite 12- itch t ewriter. : Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST. 21:G.eneratorlflD.Number+ "�'`' =X22.Page� 23.Manifest <br /> Track-Ing N�u7mber <br /> (Continuation Sheet) i €! ' '"{• �r� J 1 4 1 <br /> 24.Generator's Name <br /> U.S.EPA ID Number <br /> 25.Transporter Company Name , <br /> 28. Transporter Company Name U.S.EPA ID Number <br /> 27a, 27b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,I Number, 28.Containers 29.Tolal 38.Unit 31.Waste Codes. <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nd, <br /> A z fit <br /> 7 iMN <br /> ^fit, <br /> a <br /> a� <br /> to <br /> z . <br /> ur <br /> 32:4keraal Handling Instructions and Additional Information <br /> 30) <br /> 33,TmmDorter Acknowledgment of Receipt of Maledals <br /> H PhnWffjy-W Name Signature ( Month Da Year <br /> I ] r,. <br /> Z 34.Transporter Admowied meat of Recei fof Materials <br /> PrintedlTypedNam.. L9n?t!u?,••,• X. } .tlh. . pay,. :.Year', <br /> H <br /> } 35.Discrepancy <br /> L) <br /> d _ <br /> u- <br /> C3 <br /> LU <br /> 38.Hazardous.Wasto Report Management MethodCodes(Le.,ogdes fv-haurdous waste treatment,disposal,and recycling systems) <br /> W ; <br /> ! <br /> EPA Fenn 8700-22ARex,1U5) Previous editiflrrs,a�e:ohsolete:..: DESIGNATED FACILITYTQ GENERATOR <br />