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nt Form Approved.OMB No.2050.6039 <br /> PINIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22•Page 23.Manifea#Tracking Number <br /> (Continuatlon Sheet) <br /> 24.Generator's Name <br /> 25•Transporter Company Name ' . U.5•EPA ID Number <br /> 28.Transporter Company Name U.S.EPA ID Number <br /> 27a• 27b.U.S.DOT Dascaiptlon(tnduding Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 36•Unh <br /> HM and Paddng Group(If any)) 31•Waste Castes <br /> No. Type, Quantity 4Vt•Nol. <br /> i <br /> OC <br /> O <br /> i <br /> LU <br /> I' <br /> Y <br /> I <br /> ti <br /> i <br /> 1 <br /> r <br /> I <br /> f <br /> t <br /> } <br /> T <br /> S <br /> i' <br /> 32•Spedai Handling Instructlons and Additional informadon <br /> k: <br /> 33.Trans mentof Revel t of Matodals <br /> Uj <br /> PdntedfTyped Name ,o/ S nature� Month Day Year <br /> Jl 11q 121 <br /> (0) 34.Tran Acknowled ment of Receipt of Materfals <br /> Prfntedlfypad Name Signature Month Day Year <br /> a. <br /> ' 35.Discrepancy <br /> < a i <br /> � 4 <br /> 38•Hazardous Waste RAPW Management MahA Codes(Le.,codes for hazardous waste treatment disposal,and reoydiag systems) t <br /> EPA Form 8700.22A Rev.12-17 Previous adlilons are obsol8t® <br /> ( 1 DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />