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HI3 3q3 <br /> Please tint ort e. Form desi ned for use on elite 12- itch ewriter. <br /> UNIFORM HAZARDOUS WASTE Mt!ul-6 <br /> ator ID Number Form A roved.OMB No.2050-0039 <br /> 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> 25. Transport---LCompany Name U.S.EPA ID Number <br /> 26. Tra er C mpany Name U.S.EPA ID Number <br /> eG �.ti ` .15 1. CA/N <br /> 1n/1 v u v 1 "L L <br /> 27a. 271b.U.S.D07 Description(including Proper Shipping ame,Hazard Class,ID Number, 28.Containers <br /> HM and Packing Group(if any)) 29.Total 30.Unit <br /> No, Type Quantity Wt.NOI. 31.Waste Codes <br /> r <br /> r <br /> i <br /> i r <br /> i <br /> i <br /> � r <br /> O <br /> Q I <br /> LLI <br /> Z <br /> w <br /> c� <br /> s <br /> I <br /> r <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Trans iter -----A-cRnowie4gaieninfPpceiptofMatehals <br /> H Printed/typed Name <br /> Signature <br /> p Month Day Year <br /> d - _ <br /> Z 34.Transporter AcknoMed ment otRecei t of Materials <br /> Prinled/Typed Name gnatur <br /> t— � /1 onth ay ear <br /> 35.Discrepancy <br /> J <br /> V <br /> Q <br /> W <br /> 0 <br /> W <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> 0 <br /> rn <br /> w <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />