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Plea or type. Form desi netl for use an elite 12- itch ewriter. Farm Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 'a 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 Name �r = 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 31.Waste Codes <br /> A C <br /> HM and Packing/Group(if any))) No. Type Quantity Wtivol• <br /> r 1 <br /> i <br /> t <br /> O <br /> f.r.t <br /> Z <br /> ut <br /> c.� <br /> 32: rial Nandlirig Instructions and Additional Enformation !° T <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> LLJ Prnted/Typed Name Signature Month Day Year <br /> tY <br /> O <br /> a <br /> 34.Transporter Acknowledgment of Recei t of Materials <br /> Printed/Typed flame Signati re f, Month Day Year <br /> 35.Discrepancy <br /> F— <br /> U <br /> Q <br /> LLI <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W ` <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />