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i <br />Please print or tvoe. (Form designed for use on elite (12-oitcl,r doewriter.l <br />Form Annrnved nMR Nn 9n4n-nolo <br />EPA Form 8700-22A (Rev. 3-05) Previous edilions are obsolete, DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />21. Genera r IONumber <br />22. Page <br />23. Manifest Tracking Number <br />(Continuation Sheet) <br />\ <br />'. <br />24. Generators Name <br />e i <br />,000colNCl�.- <br />) r n <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 (if any)) <br />28. Containers <br />29, Total <br />Quantity <br />30. Unit <br />Wt.Nol. <br />31. Waste Codes <br />No. <br />Type <br />u r 1T <br />1"t%It1�tM'S'i'}Y^ )TnR'�j'7'GTT7l'� <br />i o 171.Y17"I. <br />Car�c�Ive �)c,(t�(d,��aslc r✓rzn(c,n.as, <br />GIyOxAlln�� I F IbbZbIif) 8,Un3Q(o-7 PG I I <br />I <br />90� <br />4J <br />�.. <br />Aerosol, a. I Un I115o(P'` <br />I-)m,Ffrl Qua 41k <br />3L <br />)n F kelckfed Ma�earial,n,as,un Iaco3 <br />a� I i C1�a,--s,�- I �a�► <br />I <br />cP <br />� <br />� <br />i� <br />INA", i6=�1®err 5 so�-r� <br />7 d <br />.1j '343? pb >� SeraleVb.rI� <br />✓; <br />32. Special Handling Instructions and Additional Information <br />0- <br />33. Trans rAdmowled ment of Recei tof Materials <br />33. <br />F <br />Pnntedrryped Name Signature Month Day Year <br />O <br />a <br />z <br />34. Transporter —Acknowledment of Receipt of Materials <br />Printedrryped Name Signature Month Day Year <br />N <br />35. Discrepancy <br />J <br />U <br />LL <br />D <br />W <br />G <br />36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste 6eatment, disposal, and recycling systems) <br />C7 <br />m <br />W <br />O <br />EPA Form 8700-22A (Rev. 3-05) Previous edilions are obsolete, DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />