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Please print or#ype.(Form designed'for use on elite(92-pitch)h}pemoiter.)i Form Approved.OMB No.2051}- O39 <br /> RENIFORM HAZARDOUS WASTE MANIFEST 23 Gerrera+ar It? rnber 22.Page � 23.Manifest Tracking Number <br /> (Continvation Si <br /> 24.Generafo's Narrre , <br /> r17; 1� %?'v€+?40 fjf) .ZQ11TTAN i i <br /> 25. Transpader Company Name U.S.EPA ID Number <br /> 26.Trartsporier Company Name U.S.EPA ID Number <br /> 27a. 27b,U.S,DCT Descrip2on(including Proper Shipping Name,hazard Class,ID Number, 28-Conlainers 29.Total 30.Unit <br /> HM and Pack,g Grouo(if any)) NO. Type Quantity Wt.Nol. 3# Waste Codes <br /> ;UNI 63, ASTE ?PINT RELOTED ORTCRIPt. 3 Mill F, (11t0G1) <br /> 7 <br /> Q � <br /> f� <br /> 1.1.1 <br /> Z <br /> Lil <br /> )1 <br /> 32.SpecalHaad&aglnstructiculsand Additional informationUi - x21191 tI2al1791 ;1;ii t6 INNI '�F��i�;lE�`!H �t�GHIM 529E3i21,11" ,1152 <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> LU Printedff§•ped Name Signature Monfh Day Year <br /> O <br /> CL <br /> z 34.Transpo:fer AcknovAedgment of Receipt of Materials <br /> PrintedrTyped Nama Signature MoMh Day Year <br /> 1— <br /> 35.Discrepancy <br /> tv, <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes�-,r hazardous waste treatment,disposal,and recycling systems) <br /> LUu1 <br /> O <br /> EPA Form 8700-22A(Rev.3-45) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />