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Please print or e`Farm designed for use on elite 12 itch riter. <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number Form A roved.OMB No.2050-0039 <br /> 22.P e 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generators Name <br /> 1 RECYCLED FIBERS leSAMF <br /> 25.Transporter Company Name �y 1 _ U.S.EPA ID Nu r <br /> 26. Transporter Company Name (� S.EPA ID Number I <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28 Cm <br /> HM and Packing Group(if any)) tamers 29.Total 30.Unit 31.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> O <br /> f— <br /> w <br /> z <br /> ILL! :MID <br /> C7 <br /> 32.Special Handling Instructions and Additional Information <br /> 4 33.Tire ns her Acknowledgment of Recei t of Materials <br /> PrintedlTyName ) Signature <br /> Monty Day Year <br /> CL <br /> a6 1 <br /> U) 34.Trans rte, nowled men,of Rece t of Materials <br /> PrintedlTyped Name <br /> Signature on Day Year <br /> 35.Discrepancy <br /> v <br /> 0 <br /> W <br /> Q 36.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> 0 <br /> in <br /> W <br /> D <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />