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Please print or type. SC MA PM 1"/2003 Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator N r 22.Page Z3.Manifind T in umber - <br /> (Continuation Sheet) ms $of <br /> 24.Generators Name <br /> � <br /> 25. Transport Company Name Td State NOW T U.S.EPA ID Number 000aaoaaaaa <br /> 26. Transporter Company Name U.S.EPA ID Number <br /> 27a. 271h.U.S.DOT Description(inducing Proper Shipping Name,Hazard Class,ID Number, 26.Containers 29.Total 30.Unit <br /> HM and Packing Group(if any)) ryp Typo Quantity WLNCI. 31.Waste Codes <br /> K <br /> QO <br /> K <br /> W <br /> Z <br /> W <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> r Pmltedr yped am Sign _ Month Day Year <br /> a <br /> i 34.Transporter—w Acknowledgment of Receipt of Materials <br /> Printedrryped Name Signature Month Day Year <br /> H <br /> 35.Discrepancy <br /> J <br /> U <br /> LL <br /> O <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 /> O <br />' W <br /> W <br /> O <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> F4 . 1141.4u.w hr 0. tiw "M W WII rwn!to.r to.�b MY.Nwr <br />