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,. y'- . <br />',- Please print or two. (Form desioned for use on elite ill-oitc <br />`4 <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,. Generator ID t Number <br />,AHy " ` <br />22..Page <br />.sa �- <br />23. Manifest Tracking Number <br />UUO I FLS <br />24. Generator's Name <br />-iciaouill O Rcw&hm tlwordoulb U CAS�e f -Cl <br />25. Transporter y � Company Name U.S. EPA It) - � <br />%IIIecu ( _ it' .1' a bVC.., rig_u bar <br />c3 <br />26. Transporter --�& Company Name rl U IU NUMMer <br />27a. <br />HM <br />27b. U.S. DOT Descripbon'(including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if aniNo. <br />28. Containers <br />2S. Total <br />Quantity <br />30. Unit <br />Wt,/Vo. <br />31. Waste Codes <br />Type <br />C ttSTl At...ysit t.-) t-lQuiobjKi1•Us, )u!i1719 <br />Tl.. t Sctolum t{y�fOkli . jA�1�lO�.11f�� <br />DF <br />I� <br />WA <br />Cu r©5►ve. t-tC,�tati�,f1�ir�13���,1'•furc�ut�IC, N,oS <br />1 Uhl'�Q-(w-1 ) PC, IrF1 �r J4NI—o21G AGtt�, <br />11 C1 P U21 FOCI 2r`C iryl) CN �- <br />..(JG5 <br />� <br />L7G�dIrj <br />i� <br />N � <br />101- <br />*QAJ unlPr <br />t"r'1'ltte(l. Quallit}tl) cercl.1 X240)(0 C14940(0-24 <br />00CI, <br />�[� <br />N A <br />(DI"i <br />o <br />NfAni()MIUM Nilrra Per rzer ,t NA T <br />��� ce�r�:IHO>�p�:e►�a-'�3Wu) ' <br />toaa, <br />>�' <br />ac�2 <br />� <br />A <br />�►�., <br />(7 <br />®Y�•'� IT`ST"t'T�'r�:`i.��'C � �Yr�O�^'(=.�1.�"�.•`T_��^' <br />Sr- <br />k(x Inst kC IM5I`0tc. �(�XI(. ,tu•U.S,6l,unas <br />Cil) Ci7tr.sN1,Ddu! �cYTc1�a��tY1Y��u1e 1i kA <br />otl)GC)2, <br />p►Go© <br />i Cot) <br />32. Special Handling Instructions and Additional Information �,)„+ yc10a8 __._ x 5C OF -�• C++aycco3� <br />(�)C li l ci y 606 Ci,) 0,ha40(n:�>3 RD' )ct43tg0(sd3-2-`i I <br />�'` C3"iHl �qq0 <br />y. <br />33. Trans oder Acknowled ment of Recei tof Materials <br />r <br />a� <br />Pnnt ed Name Signature ! Month Day Year <br />t ' <br />i... 1. - ,.r <br />z <br />34. Transporter Acknowledgment of Receipt of Materials <br />H <br />Ptlnted(Typed Name Signature Month Day Year <br />jl <br />LL <br />D <br />35. Discrepancy j r•+ „„ �j <br /><J.`41R Yf} i 4 K Ynrt �}Yy <br />36. NPus Wdate Report Management Mi Q�e i.e., codes for hazallous waste treatment, dis o al, and recycling systems) <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />