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Pease pnnt or type. Form Approved. OMB No. 205C-0039 GENERATOR UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. Generator ID Number 22. Page 23. Manifest Tracking Number <br />Generator's Name <br />U.S. EPA ID Number <br />Transporter _ Company Name <br />I <br />U.S. EPA ID Number <br />Transporter Company Name <br />I <br />27a. 27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class. ID Number, 28. Containers 29. Total 30 Unit 31. Waste Codes HM and Packing Group (if any)) No. -Type Quantity WtiVol. <br />_.... . ___.... <br />Special Handing Instructions and Additional Informabon USPORTER Transporter . „ _ Acknowiedgment of Receipt of Materials <br />PrintedTyped Name Signature Monte Day Year <br />I I I I <br />Transporter Acknowledgment of Receipt of Materials <br />'-- <br />I— <br />Printed/Typed Name Signature Men11-1 Day Yea' <br />I I I I <br />>—I— <br />=I- <br />5 < u_ <br />ca u.i <br />Discrepancy <br />I— .2 z (.9 <br />3€ Haza,dmrs Waste Report Management Method Codes lie., codes for hazardous waste treatment, disposal, and recycling systems) <br />I I I I <br />(75 <br />—1 <br />I I I I <br />GENERATOR'S INITIAL COPY — 8700-22A (Rev. 12-17) Previous editions are obsolete