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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) �( � 3 ci 6 2 -79S K <br /> 24.Generator's Name /� ��- } t-1-1 C <br /> l <br /> tica CA- - Rg 7 <br /> 25. Transporter 3 Company NameU.S.EPA ID Number <br /> © Q-3 ff <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> • n M 3 D <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> 31,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> i <br /> QO —^ <br /> z <br /> w <br /> i <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter__3—Acknowledgment of Receipt of Materials <br /> W Printed/Typed Name Signature Month Day Year <br /> a <br /> aRtuL,s 3 126 <br /> N 34.Transporter Acknowledgment of Receipt of Materials <br /> Z <br /> PhntedTTyped Name I Month Day Year <br /> \�)lot-►&-Ok- <br /> 35.Discrepancy <br /> F <br /> J j <br /> U 1 <br /> a <br /> LL <br /> O <br /> Lu <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z y <br /> L <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO EPA's e-MANIFEST SYSTEM <br />