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Form 4proved.OMB No,2050-0039 <br /> Please printor type. Form �eliiteitch writer. _ 23 M_ ,nH•_t 'nvprr!�UNIFORM HAZARDOGenera;r ID N� It�� H F (V��'V;1�](Continuat (j�,lr d <br /> 24.Generators Name <br /> �U.S�.E/rP�A ID Number <br /> 25,Transporter Company Name C� � � ,_ <br /> ID Number <br /> 26.Transporter Company Name <br /> 28.Containers 29.Total 30.Unit 31,Waste Codes <br /> 27a. 27b.U.S.DOT Descriptcn(including Proper Shipping Name,Hazard Class,ID Number, No. Type Quantity Wt.Nol. <br /> HM and Packing Group(if any)) <br /> a' <br /> O <br /> Z <br /> W <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Trans er ad ant of Recei t e rials Signature Month Day Y ar <br /> �u Printed/Typed Name <br /> 0 <br /> O <br /> a <br /> = 34.Trans Ackrowledgm8m of Receiptof Materials Signature on ay ear <br /> Printed/Typed Name <br /> r <br /> 35.Discmparicy <br /> J <br /> LLJ <br /> U <br /> LL <br /> Q <br /> 36.Hazardous Waste Re pod Management Method Codes p.e.,codes for hazardous waste Veatmenl,disposal,and recycling systems) <br /> 2 <br /> N <br /> W <br /> O <br /> EPA Fonn 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY <br /> DESTINATION STATE(IF REQUIRED <br /> TO <br />