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<br />21. Generator 10 Number
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<br />22. Page
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<br />UNIFORM HAZARDOUS WASTE MANIFEST
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<br />24. Generators Name
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<br />U.S. EPAID Number
<br />25. Transporter _ Company Name �, �'t„ ` 1�.v
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<br />U.S. EPA 10 Number
<br />26. Transporter _ Company Name
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<br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, 10 Number,
<br />28. Containers
<br />29. Total
<br />Quantity
<br />30. Unit
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<br />31. Waste Codes
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<br />32. Special Handling Instructions andAdditrogaiInformation r ._ 7j(� ., , (? }I � y CJ is 5(c. x 111
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<br />33. Trans derAcknoWed ment of cei tof Materials Signature '( Monts Day Year
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<br />34. Transporter Acknowledmental Recei tot Materials
<br />..nature ant Day Year
<br />Pdnled(ryped Name
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<br />36. Hazallous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)
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<br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete.
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