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•`Please print or Form designed for use on elite(12-pitch) writer. Form A roved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Genemlor ID Number P 23.Manifest Tracking Number _ <br /> s (Continuation Sheet/)/�/ � / � � <br /> 24.GeoeatWS Name( . / .. <br /> C <br /> 25, Transporter Company Name / / U.S.EPA lu Number <br /> r <br /> j u <br /> 26. Tanspoher_ Company Name <br /> 27a. 276,U.S.DOT Description(including Proper Shipping Name,Harard Class,ID Number, 28,Canrainea 29.Total 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol 31.Waste Canes <br /> aK <br /> K <br /> W <br /> 2 <br /> W <br /> i <br /> 32.Special Handing Instructions and Additional Information <br /> 2 33.Tlansporter Ad,4Wgt of Receipt of Materiels <br /> Phil Signa Month Day Year <br /> K <br /> O ' <br /> a <br /> z 34.Tanspoita/— At�iedgmert,4R.ptfMaremahs <br /> PrinmNtyped Name "We Month Day— ear <br /> 35.Discrepancy. <br /> J <br /> LL <br /> W <br /> Q 36.Hazardous Waste Report Management Method Codas(i.e.,nodes for hazardous waste testament,disposal,and recydirig systems) <br /> O <br /> rn <br /> W <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />