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Please print or h;De Jormciewned for use on elite (12-nitchl t"writer.l <br />Fnrm Annrnvwf f)MR Nn >nramlaa <br />UNIFOUWgAZARDOUS WASTE MANIFEST 21 Generator 10 Number <br />(Continuation Sheet) <br />22 Page <br />23. Aknffasl Tracking Number <br />24 Generators Name A 1 r C o <br />25 Transporter + Company Name U.S EPA ID umber <br />111 <br />U.S EPA ID Number <br />26 Transporter ^_ CoMmny Name <br />27a <br />NM <br />71b U.S DDT DescrOon (IOudrerooer ShippirlNeme ?mass 10 Nmllnber <br />and Peddrmg Group fol anr1; <br />28 <br />29.o'at <br />0-itityr <br />M-15%it <br />MAU <br />31 N(aste'Codes <br />No <br />Type <br />0 <br />z <br />32 Specaal Irstruclfonm§ and Additional Information <br />33. Ta meet of Ruc ept of Materia s <br />PniTyped NaM51 Month Day Yew <br />�~ rel C, Q j -- C"' `. � G'y /Y • 1 I 6? <br />Z <br />U. Trr _ Ack ceipt of Reof Materials <br />r— <br />NntedlTyped Name Signature Month Day Year <br />V <br />4 <br />Q36 <br />z <br />CO <br />35. Dsaepancy <br />_F <br />Hazardous Waste Ropon Management Method Codes Q.e., codes for hazardous waste treatment disposal and racy &Q systems) <br />U) <br />LU <br />0 <br />EPA Form 8700.22A (Rev. 3-051 Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />