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Please print or type.(Form designed for use or elite(12-pitch)typewriter. <br /> r. >tt 4114 <br /> , a Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generators Name <br /> 25. Transporter Company Name <br /> U.S.EPA ID Number <br /> 26, Transporter Company Name <br /> U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Prop ar Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(f any)) 31.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> :i i#1VOJI1._ fir'AS'll.:Wi? C. sf":I[ ,C#I##x f #i4�tf 3 t)l Ufd# I <br /> *,V1111 AT I F,M`413 'i PV!+G H1 (414­401 KV 1HAM 7ti C>t d>. i E "9 r - t.: <br /> €::-UN2t796,WASTE-SULI ]RIC MAD,R.1*0 II �I�I r1AC►02 <br /> r, V a i"! 5 i.' <br /> �.UN2'209, WAVE R)R I10'"Yo ',,xy#.lflm,WIWN0i X33 t l:e;a(rt ti .:: <br /> e c sS #f•All44!1 PHIC:ENT reM #.DFtj f'IIf. .ISI III r? ti 7#t es <br /> o tia.11N?14 12,IFtAb'I•#AMM "IalA`-A 1 I TIl)NS.f#.,Kj II! :,s',; �,•, - <br /> w <br /> z <br /> 0 z3 UN28019°WA SIf 1011RK1)RY CONTAINED IN MARQFAC I`I#FWD eta.,; Curry:,; <br /> F; AWI U'S,(IsdILW:16Ry Til "RWWRI.¢t, Ki('I a <br /> 32.Special Handling Instructions and Additional lnfbi maboh <br /> � .l�T'f"F�s.F�• t�"F��1.r,i 3�s.1.". _1.,C:'z t~s.� t:`1-r:•ti!"� i=::.- <br /> 15 4 1x <br /> .1�:'C°�?7r <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> Uj Printed/Typed Name Signature Month Day Year <br /> O <br /> CL <br /> U) 34.Transporter Acknowledgment of Receipt Of Materials <br /> Z <br /> Printed/Typed Name Signature Month Day Year <br /> 35.Discrepancy <br /> J <br /> V <br /> LL <br /> G <br /> W <br /> Q 36.Hazardous Waste Report Management Method C es(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> O r: ° ..4., r,I <br /> W <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions a obsolete. GENERATOR'S INITIAL COPY <br />