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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) conZ CMZ/ Z 3-9 <br /> 24.Generator's Name <br /> V40 8v S k!r(e- ,�o W fou rs+c <br /> 25.Transporter-3— Company Name n 6� ��O <br /> U.S.EPA ID Number <br /> �(/ <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 and Packing Group(if any)) No. Type Quantity Wt.Nol. 31.Waste Codes <br /> O <br /> F— <br /> w <br /> z <br /> LU <br /> C9 <br /> 1-17 <br /> 32.Special Handling instructions and Additional Information <br /> 33.Transporter Ackngwledgment of Receipt of Materials <br /> H Printed/Typed Name Signature Month Day Year <br /> a LA41 fil,, 3 <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printedfryped Name' Signature N Montthhh Day �nYear <br /> ~ � / I� •lam <br /> 35.Discrepancy <br /> J_ <br /> U <br /> Q <br /> 0 <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> W <br /> W <br /> v <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO EPA's e•MANIFEST SYSTEM <br />