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a Form Approved. OMB No. 2050-0039 <br /> pjease tint or e . Form designed E use IF elite 121 Generator D 'Number 22. P e 23. Manifest Tracking Number _ <br /> UNIFORM HA7ARDOUS WASTE MANIFEST fl � <br /> (Continuation Sheet) <br /> 24, Generator's Name <br /> f . <br /> skill <br /> CJ <br /> U.S. EPA ID Number <br /> 25. Transp er Company me i ^ il Iry <br /> LC <br /> Lt T <br /> S. EPA ID Number <br /> 26. Transporter col Name 3 <br /> * C <br /> 27a• 27b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, Number, 28. Containers P29, Totall30. Unit 35 . Waste Codes <br /> HM and Packing Group (if any)) 7 No. TypeuantityWL/Vol, <br /> a <br /> O <br /> W <br /> Z <br /> W <br /> C7 <br /> 32. Special Han ing InsWctions andAddilionai Information <br /> 33. Transporter Acknowledgmentof Receipt of Materials 1 11 1 Month Day Year <br /> H Printed/Typed dame Signature f <br /> � "� r f 7 <br /> O <br /> UA Trnnca <br /> Pdntedrr Na <br /> Signature on ay ear <br /> 35. D crepancy <br /> J_ <br /> V <br /> 0 <br /> a36. Hazardous Waste Report Management Method Codes like., codes for hazardous waste treatment, disposal, and recycling systems) <br /> Z <br /> 0 <br /> U) <br /> [�LU <br /> 0 <br /> EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />