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Please print or type. Form Approved,OMB No.2050-0038 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121 G n roto IDN be 22.P a 23.Manlfeit Tracking Number <br /> tConllnuatlon Sheet) 2 ( r <br /> 24.Generators Name <br /> 25.Transporte e2 Company Name i , ' 11.S•EP�t I<�ii e <br /> 28. Transport pany Nam�bQs�' <br /> ]� Tm- 1 <br /> 1N�"�MU. EPA� J r <br /> 27a. 27b.U.S.DDT Descdpbon(including Proper Shipping Name,Hazard Class,10 Number, 28.Containers 29.Tblal 30.Unit <br /> 31.Waste Codes <br /> HM artid Packing Group(If any)) No. Type Quantity wt./Vol, <br /> 04 <br /> Oa ' <br /> [Y . <br /> Z <br /> Am <br /> c9 <br /> r <br /> 32.Special Handling Instructions andAddhional Informatlon <br /> iI <br /> tl <br /> 33,Transport, wt meet of Recei tof Mated <br /> FPdnted(Fyp Signalu Month Day nYe`ar <br /> p UZ 7 21 <br /> i 34,Trans rte awied meal of Receipt of Materials <br /> PdnledfEyped Signature Month Day Year <br /> 35.Discrepancy <br /> ZI <br /> U <br /> W <br /> Q � ' <br /> a36.Hazardous Waste Report Management Method Codes(!,a,,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 <br /> o <br /> EPA Form 8700.22A(Rev,12.17) Previous editiohsare obsolete. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br />