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Please print or type. (Form designed for use on elite (12-pitch) typewriter) Form Approved. OMB No. 2050-0039 <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. Generator ID Number <br />- <br />23. Manifest Tracking Number <br />i ) <br />24. Generator's Name(- _ <br />T1 fJ( <br />I � r Aa 7 � --, �O ✓ C J / <br />25. Transporter Company Name U.S. EPA ID Number <br />Po P Y „•r m <br />26. Transporter Company Name U.S EPA ID Number <br />27a. <br />HM <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28, Containers <br />2g. Total <br />Quantity <br />30. Unit <br />Wt <br />31. Waste Codes <br />No. <br />Type <br />a' <br />O <br />W <br />Z <br />W <br />32. Special Handling Instructions and Additional Information <br />33. Transporter Acknowledgment of Receipt of Materials <br />W <br />ccO <br />a <br />Printed(fyped Name Signature Month Day Year <br />Z <br />34. Transporter---Acknowledgment of Receipt of Materials <br />Printed(Typed Name Signature Monti Day Year <br />J <br />U <br />W <br />D <br />W <br />35. Discrepancy <br />Q <br />Z <br />O <br />rn <br />36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />W <br />D <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />