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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number _ <br /> (Continuation Sheet) <br /> 24.Generators Name <br /> G i <br /> 25.Transporter _ Company Name EP D Num <br /> - 'W. <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 Quantity Wt./Vol. <br /> i <br /> Yr <br /> �Q <br /> N <br /> W <br /> Uj <br /> W � <br /> � 3 <br /> s <br /> i <br /> f <br /> x <br /> t <br /> g. <br /> t ( <br /> 32.S cial Handling Instructions and Additional Information <br /> s <br /> ( <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> w Printed/Typed ame Signature Month Day Year <br /> 34.Transporter Acknowledgment of Receipt of Zterials <br /> Printed/Typed Name Signature Month Day Year <br /> t— <br /> 35.Discrepancy <br /> V <br /> L <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) ` <br /> z <br /> C7 <br /> w <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's smMANIFEST SYSTEM <br />