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i <br /> (Form designed for use on elite(12-pitch)typewriter) Farm Approved.OMB No.2050-0039 <br /> jlZARDOUS WASTE MANIFEST 21 Genem tor ID Nfu�mber (/����� 22 Pa q_7 23.Manifest Tracking Number t� <br /> r(Continuation Sheet) cGV 20 <br /> v 1 n U.S.EPA ID Number <br /> r27a, 27b. <br /> Transporter Company Name �J ./ <br /> /\ C C—t I ll / 0 l0(f t1 <br /> Company Name <br /> U.S.EPA ID Number <br /> OT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> g Group(if any)) No. Type Quantity Wl.Nol. 31.Waste Codes <br /> aO <br /> a <br /> W <br /> Z <br /> W <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter i Acknawlod merit of Receipt of Materials <br /> H PrImmyfyped Name <br /> � Signature Month Day Year <br /> 34.Transporter__Ackrx�wlod rnenl of Receipt of Maledals <br /> Pnnled7Typed Name Signature Mnnlh Day Year <br /> 35.Discrepancy <br /> a <br /> U <br /> LL <br /> O <br /> W <br /> Q 36 I lazardous Waste Report Management Molhod Codes fs.e.codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> 0 <br /> co <br /> W <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />