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....I 1..,n -- nnh "I -3-M t <br />Form Aocroved. OMB No. 2050-0039 <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED. FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. GeneratoriD Number <br />ffAC0026-7304 <br />22. Page <br />23. Manifest Tracking Number <br />OOL4 q 01 r t -E <br />24. Generams s Name <br />12AA08Al1IC A) - A. <br />U.S. EPA 10 Number <br />25. Transporter Company Name <br />U.S. EPA iD Number <br />26. Transporter Company Name <br />27a. <br />HM <br />27b. U.S. DOT Description including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Containers <br />29. Total <br />Quantity <br />30. Unit <br />Wt.Nol. <br />31. Wsale Codes <br />No. <br />Type <br />/Jowl 2GIeM1 1{A Z A de 00 JS WASTE LI QJ10 <br />(it LILOA)g Dtax1 015 501-0 1 VAJ) <br />—7 <br />�Y <br />31SO <br />fn� <br />r <br />Ibf <br />0 <br />w <br />z <br />w <br />O <br />r <br />32. Special Handling Instructions and Additional Infommumn <br />5)0`701315'70-1-1204; PAU-n3�2-030 7.VS5.010 <br />K <br />33. Trans er Acknowled mant of Receipt of Materials <br />W <br />K <br />O <br />Primecirryped Name Signature Month Day Year <br />a <br />= <br />34. Transporter_Aclencovedginant of Receipt of Materials <br />F— <br />Prlmedffyped Name Signature Month Day Year <br />J <br />a <br />LL <br />D <br />35. Discrepancy <br />' <br />z <br />O <br />36, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />y <br />W <br />O <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED. FACILITY TO DESTINATION STATE (IF REQUIRED) <br />