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r <br />Please print or type. (Form designed for use on elite (12-uitc,.,ou ter.) 1:. - <br />Form Approved_ OMR No 7n6n-00.49 <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21.1 enerator ID Number r., - <br />C � + ll`� <br />22. Pae <br />23. /Manifest Tracking Number _ <br />Wk— q � .) � � � <br />24. erator's Name <br />n .)C<a W n i�t0 <br />25: Transporter Company Name U.S. EPA ID Number <br />C A �,r L. 1 1A)f s4 L v <br />1, ` f t f`ho �a.j <br />26. Transporter Company Name U.S. EPA IO Number <br />27a, <br />HM <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group III any)) <br />28. Containers <br />29. Total <br />Quantity <br />30. Unit <br />Wt:Nol. <br />31. Waste Codes <br />No. <br />Type <br />AerosoIt), d,(�piach nvt-excrfri► <br />Ater, cGaac,f}Y) <br />C2- <br />CF <br />7 <br />i <br />N <br />K <br />0 <br />r— <br />W <br />Z <br />W <br />tr <br />32. Spedal Handling Instructions and Additional information <br />C i4yOtoo_– k tt1' F <br />�i AICr C`_J 1CP— i; -i c:3 <br />W <br />33. Transporter Acknowled meet of Receipt of Materials <br />h <br />O <br />a <br />PnntedfTyped Name Signature Month Day Year <br />z <br />34. Transporter Acknowiedgment of Receipt of Materials <br />r <br />Printed/Typed Name Signature Month Day Year <br />- <br />zi <br />LL <br />O <br />W <br />3F Discrepancy - <br />Q <br />z <br />O <br />3 azaMous ste Report Management Method Codes(i.e., codes forhazardous waste treatment, disposal, and recycling systems) <br />it <br />V <br />N <br />W <br />O <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />