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" Pleassle Orint or type. (Form designed for use on elite Ich) typewriter.) <br />Fomr Approved. OMB No. 2050-0039. <br />Style CF18 w[pSL r 0le00)621-5808 wvw.a masteocm EPAFwm8700-22A (Rey 9-88) Previous editions are obsolete. <br />�nwrmoarccxiear�rrn� °�'1" FILE COPY'OR STATE COPY <br />UNIFORM HAZARDOUS <br />21. Generaror's US EPA ID No. <br />Manifest Document No <br />22. Page <br />Information in the shaded <br />WASTE MANIFEST <br />areas is not required by Federal <br />(Continuation Sheet) <br />law. <br />23. Generators Name - - _ - <br />L. Stale Manifest Document Number <br />M. State Generator's ID <br />24. Transporter Company Name <br />25. US EPA ID Number <br />N. State Transporter's ID <br />O. Transporters Phone <br />26. Transporter_ Company Name <br />27. US EPA ID Number <br />P. State Transporters ID <br />O. Transporter's Phone <br />28. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />29. Containers <br />30. <br />Total <br />31. <br />Unit <br />R. <br />Waste No. <br />aM <br />No. Type <br />Quantity <br />Wt[Vol <br />a. <br />b. <br />r <br />s <br />C. <br />G <br />d. <br />E <br />N <br />E <br />fl <br />A <br />e. <br />T <br />O <br />R <br />f. <br />9 <br />h. <br />I. <br />S. Additional Descriptions for Materials Listed Above <br />- <br />T. Handling Codes for Wastes Listed Above <br />32. Special Handling Instructions and Additional Information <br />r <br />6R V <br />r= <br />T <br />R <br />33. Transporter Acknowledgement of Receipt of Materials"`"'" <br />Date <br />Printed/Typed Name <br />Signature <br />onth Day Year <br />N <br />s <br />P <br />0 <br />R <br />34. Transporter _ Acknowledgement of Receipt of Materials <br />Date <br />Printed/Typed Name <br />Signature <br />onth Day Year <br />E <br />R <br />F <br />A <br />35. Discrepancy Indication Space <br />— <br />C <br />L <br />T <br />y <br />Style CF18 w[pSL r 0le00)621-5808 wvw.a masteocm EPAFwm8700-22A (Rey 9-88) Previous editions are obsolete. <br />�nwrmoarccxiear�rrn� °�'1" FILE COPY'OR STATE COPY <br />