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e <br /> Please rint or type. Form desi ned for use on elite(12-pitch)typewriter.) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.GeneratorlD Number 22.Page 23.Manlie stTracking Number <br /> (Continuation Sheet) CA <br /> R5, lq� S r y ?�� <br /> 24.Generators Name t t <br /> 25.Transporter 3 Company Name U.S.EPA ID Number <br /> ✓ ` L d!1� zc <br /> 26.Transporterpany Name U.S.EPA ID Number <br /> Va. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> H and Packing Group(if any)) No. Type Quantity Wt Nol. 31.Waste Codes <br /> QO <br /> w <br /> z <br /> w <br /> t� <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> H Prin sped Name Sign e <br /> e� Month Day Year <br /> CL <br /> Z 34.Trans rter Ackrwwl ment of numpt of Materials <br /> jl 1 <br /> Printe/Typed Na e <br /> ig a p;nth Day Year <br /> Discrepancy <br /> U <br /> LL <br /> D <br /> W <br /> a 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> c� <br /> w <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />