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(Form designed �Or use elite (12-pNch) typewriter.) <br />Form Approved, OMB No. 2050-0039 <br />HAZARDOUS WASTE MANIFEST 21.Oenenb ID Nvmsber <br />:.:(CorMnuaUon sheet) • e <br />21. Pap <br />2 <br />23. Man t nq <br />�$ --T-5K <br />�/. (;anerabfs Name <br />25 Transporter_— Company Name U.S. EPA ID Number <br />SLT iDCPRJ! U WAY INC. ur"Wwo"M <br />U.S. EPA ID Number <br />29. Transporter Company Nemo <br />27s. <br />HM <br />27b. U.S. DOT Desaipfon (trwMinp Proper ShlpM NameI'Hazard fess, ID Number, <br />and Pecl* G -p (0 any)) <br />28. Containers <br />29. Total <br />Oumuty <br />30, UNt <br />VAM• <br />31, WOala Codes <br />No, <br />Type <br />I <br />W <br />Z <br />w <br />c� <br />. <br />32. Special Haodirg iOuctlons and Addbonal Information <br />27A i 2M LMH kww. ARE TRANSP011111TAW <br />W ONLY ar aro TRANSPoI M <br />33. lwqottw Adrawledgment of Receipt of Materiels <br />Prkded/lyped Nanta � � <br />Signature Montle Day Year <br />A4rn <br />34. Transporter AdmoWedpwA of Repel t of Maferpts <br />Printed/Typed Name I <br />S�rs�yg Month Day Year <br />35. D oorepency <br />Q <br />d <br />Q36. Hazardow Waste Report Manapement Method Codes 0.e., models for hazardous waste habnad, disposal, and racycli g systems) <br />S2 <br />rn <br />W <br />Q <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />