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ort e.(Form tleslgned for use an elite(12-pltU)typewriter.) Form Approved.(WONo.2050-0039 <br /> dMFORM HAZARI)OUE WASTE MANIFEST erakrlO Number 22 23.ManlfartT ckln9N mbar, <br /> (Continuation Sheet) <br /> 24,Generalms Name <br /> 25.Frans Derry Ne `—� 11 . ' U.S,EPAID Numbe, <br /> 1 A� <br /> U.S.EPA ID Number <br /> 26.Tmnspo,lar_Company Nance , 1 <br /> 27e, 27b.U.S.DOTOearYpecn(indWmg Proper Shygrg Name,HazaN Class,iO Nembeg 28.Conkinem <br /> 29 Total3b.Un31.Waste Codes <br /> HM and PadMil Group(Bam')I No. type <br /> a <br /> 717 <br /> I <br /> I <br /> i <br /> I <br /> I <br /> i <br /> a <br /> o <br /> w I <br /> ( <br /> (I <br /> `III <br /> I <br /> I <br /> , <br /> 32.Speckl Handlhg InslmNms endAddllland Inbrtnalion i <br /> d,*T ' Ark owtedgmentofReceint prAletedals <br /> i signature MonroDayk � �t9� !'L <br /> 6 <br /> z 34.Trans r_AcknaM memof RecelptofMaledals j <br /> Prhledlrypod Name Signature Mono Day Year <br /> 35.01snePancy <br /> U <br /> 6 <br /> LL <br /> Q <br /> 36.HaauNous Waste Repad Managerrenf Method Codes p.e.,ratios for hazardous waste Veam:en4 disposal,and recycling systems) <br /> z <br /> rp <br /> N <br /> W <br /> Q <br /> EPA Form 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED � <br />