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Please print or type. ' Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 2t.Generator!( Num% 22.Page/j _ 23.Manifest racking Number <br /> (Continuation Sheet //� <br /> 24.Generators Name 71 <br /> U.S.EPA ID Number <br /> 25. Transporter Company Name <br /> ah <br /> U.S.EPA ID Num er <br /> 26. Transporter Company Name <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)) <br /> No. Type Quantity Wt.Nol. <br /> O <br /> w <br /> z <br /> W <br /> c7 <br /> '00, <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> WPrintedffyped Name Signature Month Day Yeat <br /> a (� \) <br /> N 34.Transporter Acknowledgment of Receipt of Materials <br /> Z <br /> Printed/Typed Name Signature Month Day Year <br /> H <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> O <br /> Q36,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> 0 <br /> N <br /> LU <br /> v <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO EPA's e-MANIFEST SYSTEM <br />