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Please print or type. Form designed for use on elite 12- itch typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) 34'i If <br /> 24.Generator's Name t <br /> '(A 4py t' t:ti ;i t<if_'tjE:t''�..4�.ft r'�P1�1�.i 1.04 '1) <br /> 25. Transporter Company Name <br /> 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('d any)) <br /> No. Type Quantity Wt.Nol. 31.Waste Codes <br /> +"!�AlPiJ I':(-Yl:'.r;Iti ai�'+Lwi�i97,. )} + <br /> � I <br /> r <br /> t <br /> 0 t <br /> O <br /> z <br /> LU <br /> C7 <br /> r <br /> 9 <br /> 7 <br /> t <br /> 1 <br /> r <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Tran sporter Acknowledgment of Receipt of Materials <br /> w Pdntedfr <br /> YPed Name Signature Month Day Year <br /> O <br /> IL <br /> Z34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> H <br /> 35.Discrepancy <br /> Zi <br /> V <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 /> O <br /> Cn <br /> LU <br /> o ' <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />