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i <br /> Please print or typo. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator ID Number 22 Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> U.S.EPA ID Number <br /> 27a, 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28,Containers 29.Total 30.Unit <br /> HM and Packing Group(if any)) 31.Waste Codes_ <br /> No. Type Quantity Wt.Nol. <br /> ul',-.u: L'Iit ri. i_10julrl <br /> O <br /> W <br /> z <br /> w <br /> C9 <br /> 32.Special Handling Instructions and Additional Information <br /> 33-Transporter Ac*riowledgment of Receipt of Materials <br /> H Printed/Typed Name Signature Month Day Year <br /> O <br /> a <br /> z 34.Tramsporter Acknowledgment of Receipt of Materials <br /> PrintedlTyped Name Signature Month Day Year <br /> } 35.Discrepancy <br /> J_ <br /> V <br /> Q <br /> LL <br /> 0 <br /> W <br /> a 36,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> C7 <br /> Cn <br /> w <br /> 0 <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />