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Please print or type. Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 111TW&66TV <br /> rtDNu Pu <br /> Z Pgge� 23,,MaOn4t s touy�er t � �(Continuation Sheet) //Vj}} �V'1 V <br /> 24.Generator's Name <br /> 25.Transporter CompapyName 1 yl�y � �`/�t�/•� � UP EP Num r <br /> l <br /> WS EPI Number <br /> 28.Transporler ompany Name• n <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,IQ Numbsr, 28.Contalnera 29•Fatal 30.Unit L• <br /> 31.Waste Codes <br /> HM and Packing Group(Itany)) No. Type Quantity W11V01. <br /> tr <br /> ILIO <br /> cY <br /> Z <br /> to <br /> 32.Special Handling Instructions and Additional Information <br /> if <br /> C 33.TranspOer Acknowiedgmentof Recai I of Materials <br /> PAntedlTypeAName Signa ih D y r <br /> a LV� dc2. i <br /> 2 34.Transporter owWgmontofRow1ptofMatafia[jL <br /> PdnleOfyped Sjoatu Month Day Year <br /> 35.Discrepancy <br /> ...r <br /> t <br /> a ' <br /> 0 <br /> w <br /> a 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 <br /> uNi r <br /> O <br /> I=PA Form 8700.22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />