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Fora Approved,OMB No.2050-0039 <br /> Please print or type. <br /> UNIFORM HAZARDOUS WASTE MANIFEST <br /> 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) C At <br /> 24.Generator's Name <br /> 11.5.EPA ID Number <br /> 25. Transporter Company Name `` <br /> U.S.EPA ID Number <br /> 26.Transporter Company Name <br /> 27a. 2A U.S.DCT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29,Total 30.Emit 31.Waste Codes <br /> HILI and Packing Group(if any)) No, Type Quantity Wt.lvol. <br /> I O <br /> LU <br /> z <br /> ua <br /> C9 <br /> i <br /> 32.Special Handling Instructions and Additional Information <br /> 33-Transporter Acknoaaledgment at Receipt of Malerials <br /> LU PrintedlTyped Name Signature Month Day Year <br /> O !' •r , <br /> n_ <br /> rn 34.Transporter Acknowledgment of Receipt of Materials <br /> Z Month Day Year <br /> ¢A, PrintedlTyped Name Signature <br /> } 35.Discrepancy_i <br /> F <br /> .:.r <br /> U <br /> ti <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems( <br /> c3 <br /> co <br /> Lu <br /> f � <br /> DESIGNATED FACILITYTO GENERATOR <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. <br />