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4"Ise' print or type. Pom1 designed for use on elite (12 -pitch) typewriter.) <br />• ��- Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. <br />DESIGNATED FACILITY TO GENERATOR <br />n <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />121. Generator ID Number <br />C H V 1 Do 0414 <br />22 - Al. <br />G <br />23, Manifest Tracking Number .�7 <br />�-%OO �.T5J g / f•" (,,,. � <br />24, Generator's Name <br />U.S. EPA, ID Number <br />25. Transporter Company No <br />UmHaftrs Environmental Services <br />26. Transporter_ Company Name U.S. EPA ID Number <br />27a. <br />H <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number,.Conta <br />and Packing Group if any)) <br />inersM <br />29. Total <br />Quantity <br />30, Unit <br />Wt.Not. <br />31. Waste Codes <br />No. <br />Type <br />cc <br />0 <br />w <br />z <br />w <br />0 <br />32. Special riling Instructions and Additional Information <br />33.Trans der Acknowled mentof Recei tof Materials <br />w <br />Prim yped ame \ <br />c azure <br />Month D Year <br />Z <br />34. Transporter Acknowledment of Recei tof Materials <br />H <br />Printedlryped Name signature Month ay Year <br />Y <br />Q <br />Q <br />LL <br />D <br />35. Discrepancy <br />W <br />z <br />c� <br />36. Hazardous Waste Repan Management McNotl Codes (i.e., cotles for hazardous waste treatment disposal, and recycling systems) <br />N <br />W <br />D <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. <br />DESIGNATED FACILITY TO GENERATOR <br />n <br />