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Pt`ease lint or Form designed for use on elite 12- itch ewdter Form roved.OMB No.2050 0039 <br /> t£ UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator ID Number23.Manifest Number <br /> ' 22.Pag <br /> i <br /> (Continuation Sheet) , <br /> 24.Generator's Name <br /> U.S.EPA ID Number <br /> --25.Transporter Company Name' / DO <br /> r <br /> U.S.EPA ID Number <br /> 26.Transporter Compan Name C�/� <br /> C>(/� <br /> i <br /> 27a, 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Nu` 28.Containers . 29.Total" 30.Unit 31.Waste Codes <br /> HM and Pacidn9 Group(if any)) No. Type Quantity Wt.N01. <br /> I <br /> i <br /> i <br /> W <br /> Z <br /> 32.Special Handling instructions and Additional information <br /> 33.Trans xter Adcno ment of Recei t of Materials Month-ay Year <br /> LU Pdnted/Typed Name Signature /J <br /> O G \ <br /> n. <br /> V 34.Trans der Admowled men f Race!t of Materials Month Day Year <br /> Printed/Typed Name S gnature <br /> } 35.Discrepancy <br /> H. <br /> tL <br /> W 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> ca <br /> U) <br /> W <br /> 0 <br /> EPA Form 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />