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: Please ase print or type. (Form designed for use on elite itch) typewriter.) <br />Form Approved. OMB No. 2050-0039. <br />Style CF 18 LAsELFiAsnat 0(eoo) wi-sans ww iaeelmasrer corn EPA Form 0700.22 A(Rev. 91 Previous editions are obsolete. <br />GENERATOR COPY <br />UNIFORM HAZARDOUS <br />121. Generators US EPA ID No. 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. State Manifest Document Number <br />M. State Generator's ID <br />24. Transporter Company Name 25, US EPA ID Number <br />N. State Transporter's ID <br />O. Transporters Phone <br />26. Transporter Company Name - 27. US EPA ID Number <br />P. State Transporters ID <br />O. Transporters Phone <br />29. Containers <br />30. <br />31. <br />R. <br />28. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />Total <br />Unit <br />Waste No. <br />RN <br />No. Type <br />Quantity <br />WUVol <br />a <br />.... <br />--C,, <br />t� <br />b. <br />C. <br />G <br />d. <br />E <br />N <br />E <br />R <br />A <br />e. <br />T <br />O <br />R <br />1. <br />9 <br />h. <br />L <br />S. Additional Descriptions for Materials Listed Above <br />T. Handling Codes for Wastes Listed Above <br />Dh <br />32. Special Handling Instructions and Additional Information <br />T <br />33. Transporter Acknowledgements of Receipt of Materials <br />Date <br />R <br />A <br />Prigted/ Typed Name .�+ <br />Sigrature <br />Month Day Year <br />P <br />0 <br />34. Transporter Acknowledgement of Receipt of Materials <br />Date <br />R <br />T <br />Printedifyped Name <br />Signature <br />onth Day Year <br />R <br />A <br />35. Discrepancy Indication Space <br />c <br />L <br />T <br />y <br />Style CF 18 LAsELFiAsnat 0(eoo) wi-sans ww iaeelmasrer corn EPA Form 0700.22 A(Rev. 91 Previous editions are obsolete. <br />GENERATOR COPY <br />