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Please Drint or Woe. (Form desioned for use on elite f19-ha,h1 <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 />21. Generator ID Number <br />22. Page <br />Ful I I I APPFVVVU. JiVic 110. cUJu-VUJa <br />23. Manifest Tracking mber <br />(Continuation Sheet) <br />(,/'�H' v/CJp� - <br />pp o 3. <br />g $ <br />L3 `�� <br />24. Generator's Name <br />1-0vE 1,4 <br />25. Transporter Company Name <br />U.S. EPA ID Number <br />26. Transporter Company Name <br />4 1 <br />u <br />27a. <br />HM <br />27b. U.S. DOT Description (inclutling Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Containers <br />29, Total <br />30. Unit <br />31. Waste Codes <br />No. <br />Type <br />Ouanuty <br />WLNoI. <br />A _4-n AI -feel c -/ 3 uiry/ati <br />Pc ly (l /28)PjC <br />es <br />I <br />AV <br />ov <br />e <br />o o <br />r- <br />ve L/Qka-Z>1 A^ / e. <br />uA; ;?I- � <br />/� <br />l <br />�Nr� 7Ptc o� 4 C 7 <br />Cil <br />a3cl <br />0 k 4A iZ/^/ 6-7 W r 0 / S. /, llrV ly7�fi /0 <br />lam, <br />t�$ % <br />&1Z <br />Ole) (PP b9 <br />— <br />O <br />�X /!7/Z/ Ni e7 1.4 V V -D N � S 1, UA.)/y 7'/'�/g <br />I /C�lu�Fb3y48z� <br />P, PO%yCHf O(l/A-W. / / YOWY 5/gi <br />s <br />N 7211 ���5 LL CDw>e+� S�vicc��z�/Z/sy/ <br />�� <br />"vwF z <br />7' <br />C�5/J ClEilorJ� %}G /e.._ n2cYGagr/i� <br />e"�% <br />/Z <br />LSU/ <br />C���/Ccs 2-Z UrV 077- <br />6� <br />OoL <br />i;- <br />32. Special Handling Instructions and Additional Information <br />33. Trans er Acknowledgment of Receipt of Materials <br />w <br />Printedrtyped Name Signature <br />Month Day Year <br />O <br />a <br />= <br />34. Transporter Acknowledgment of Receipt of Materials <br />Pnntedrfyued Name Signature <br />Month Day Year <br />v— <br />35. Discrepancy <br />J <br />U <br />Q <br />LL <br />Q36. <br />Hazardous Waste Report Management Method Codes (i.e.. codes for hazardous waste treatment, disposal, and recycling systems) <br />z <br />C7 <br />w <br />w <br />D <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />