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desi ned for use on elite(12-pitch ler.) Eon Approved.OMB No,2050-0039 <br /> 1 ROOUS WASTE MANIFEST 21.OeneretorlD Numbs®® 22.Page 23.Manifest yjtl gjl �j <br /> Con0nuatlon Shoot) ice✓ L�J/1 <br /> I.Ge odVs Name <br /> mer <br /> 25.Transporter Company Name Q'S.F)MIDNuRq <br /> 3 <br /> IY/ U�VSp.7�EPA 10 Number <br /> 26.Transporter_Company Name <br /> 27a. 27b.U.S.DOTDasoflplbn Oncluding PmperShippin9 Name,Hazard Class,10 Number, 28.Containers 29.Total 30.Unit <br /> 31.Waste Codes <br /> HM and Paddrg Greup(denyp No. Type Quantity WtNol. <br /> tY <br /> O <br /> W <br /> a <br /> w <br /> co <br /> 32 Spedol Handling InsWc#ons andAdditional Information <br /> Ise 33.Trans AdmoM mentalR of Materials <br /> f P' ypedN Sig u Month Day Y <br /> ( <br /> O <br /> a <br /> N 74.Transporter Aanowemoot ofR al Materials <br /> Pdntedlryped Name 3gnalure Monk, Day Year <br /> N <br /> 35.Disaepamy <br /> V <br /> Q <br /> LL <br /> O <br /> 38.Hazardous Waste Report Management Moored Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> N <br /> W <br /> O <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />