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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Ge ID Numbe 2jt Page P3.I�rnlfakl Hu <br /> (Contfivallon Sheet) <br /> 24.Generatoes Name <br /> � (A -ajL , EPAumber <br /> �� d <br /> 25.Transporter Company Name N 1 <br /> 06 C) <br /> 26.Transporter Company Name U.S.EPAID Number <br /> 27a. 27b.U.S.DOT Desaiptfon(Including Proper Stripping Name,Hazard Class,ID Number, 211.Containers 20,Tota1 3Q.Unit <br /> HM and Paddng Group(Il any)) No. Type Quantity wtivol, 31.Waste Codes <br /> 41fw W1. <br /> J <br /> I <br /> i <br /> I <br /> 32.Spedal Handling Instructbats and Additlonal Information <br /> i <br /> 33.Transporter arent of Receipt of Mat.W. <br /> Fw— Pdntedfryped Name Signature Month Day Year <br /> N 34.Tra r AdurovA ment of Racelpt of Malerlals <br /> PdntWffyped Name Signature Month Day Year <br /> r <br /> 35.Disaepancy <br /> v <br /> LL <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> C7 <br /> y <br /> W <br /> D <br /> EPA Form 87OD-22A(Rev.12-17) Previous editions are obsolete, DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br />