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Please print or type, Form designed for use on elite (12 -pito., , ewriter. <br />Form Approved . OMB No 2050-0039 <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />1 21. Gen ato1rJ/D Number C,, <br />G ��7 { �� �(y(�7v y <br />22. Page <br />23. Manifest Tracking Number <br />24. Generato/s Name <br />25. Transporter Company Name U.S. EPA ID Number <br />26. Transporter Company Name U.S. EPA ID Number <br />27a, <br />HM <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group(H any)) <br />28. Containers <br />29. Total <br />Quantity <br />30. Unit <br />I Wt./Vol. <br />31, Waste Codes <br />No. <br />Type <br />J9A4V Gat> M -V pw r//�i(ctJa2 <br />t9n,lr�wSoPqtj)3. <br />6: <br />P'AWA7w3cr mer✓ Toric�3.y i <br />wV 1997,94 <br />0 <br />0 <br />W <br />Z <br />W <br />32.E ficial Handling Instructions and Additional Information <br />J� J\ c //y G 0)1- 1k, <br />33. Transporter Acknowledgment of poo t of Materials <br />W <br />K <br />O <br />Pdntedrtyped Name Signature Month Day Year <br />a <br />z <br />34. Transporter Admmled mento(Receipt of Materials <br />H <br />PrintedlTyped Name Signature Month Day Year <br />J <br />U <br />uE <br />D <br />35, Discrepancy <br />a36. <br />z <br />cv <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />rn <br />W <br />D <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />