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Please print or type. Form designed for use on elite 12- tchtypewriter.) Form Approved.OM©No.20500030 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21. emtor ID Number 22,Page 23.Manlfest Tracking Number <br /> (Continuation Sheet) <br /> G <br /> 24.Generators Name j <br /> 25 Transporter Company Na U.S.EPA ID Number <br /> K )0'1111:�L <br /> Zz <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> 27a, 27b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30,Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt Noi. <br /> i� <br /> i <br /> b <br /> O <br /> w i t <br /> Uj i <br /> ) <br /> I <br /> t <br /> r <br /> t <br /> 32.Special Handling Instructions and Additional Information <br /> rY 33.Tran rte Ack.,1e ment of Receipt of Materials <br /> LIJ Printed/Typed Name Signature Month Day Year <br /> 0 <br /> a <br /> Z 34.TranAcknowledgment of Receipt of Materials <br /> PNnted[7yped Name Signature Month Day--7e—ar <br /> F- <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> u.. <br /> C3 <br /> w <br /> a 36.Hazamous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal.and recycling systems) <br /> z <br /> t7 <br /> w <br /> O <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. Uf FilGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />