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Please print or type. (Form desianed for use on elite (12-oitchi ivoewriter 1 <br />Rnrm Annrnvpd T)dR Nn 9n5n-nn3a <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 />(Continuation Sheet) <br />121. Generator ID Number <br />ICA// coo 50`% <br />22. Pa�je <br />� C — <br />23. Manifest Tracking Number _ <br />(70 0 3355 69,5 FLG <br />24. Generator's Name <br />G�vF� rPc�-7a003rc-.e 7iv7r <br />25. Transporter �_ Company Name r^ <br />Czz24--J H4 h=4?v25 <br />EPA D <br />uorder <br />0 3 g 2 Za ScJ <br />26. Transporter Company Name <br />- 'umber <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 />- <br />Quantity <br />30. Unit <br />WI NoI. <br />31 Waste Codes <br />No. <br />Type <br />�A�'ilu t*iriD,t�+fl�%r kc ,�Uda <br />y 17, <br />rj7 <br />�/ <br />€'LAw#/c'r " -p,�ID 4/v C --ti <br />WjLr v -oj <br />d/7/ <br />R?G <br />� <br />>✓/ <br />e��✓ji4-�fi/�Ct; tires <br />c '�' a r'�.a 71 I � Pc, F ��v iz r� M� <br />60 <br />�3: <br />.a o <br />6/ <br />o <br />W <br />j4,r4m 1am flZ/P7�1-/177 <br />I„i'loN7071P41i l'47&&7l'r0 ,r%F 7<u7�iy <br />oa <br />P ✓ <br />01'>Z�° ` <br />17 <br />/ <br />67 <br />A <br />Pb I <br />Lip A ✓%j pk <br />�%�G 6T71' Zrll y�GLZ� s1/17j� $. �� /r17y7g <br />647 SIO f- cptc&top L_ <br />��/� <br />✓ <br />ts3"� <br />O ycA <br />ca <br />tL/ <br />_ <br />32. Special Handling Instructions and Additional Information <br />33.Trans rter Acknowletl mentof Receipt of Materials <br />W <br />K <br />O <br />a <br />Pdnted(Typed Name Signature <br />Month Day Year <br />Z <br />34. Transporter Acknowted ment of Receipt of Materials <br />PrintedlTyped Name Signature <br />Month Day Year <br />J <br />U <br />Q <br />W <br />W <br />35. Discrepancy <br />Q <br />2 <br />O <br />36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recyGing systems) <br />N <br />W <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />