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Please print or type. (Form designed for use on alit -pitch) typewriter.) <br />Foran Approved. OMB Na 2050-0033 <br />Style CF to LABELAAsTFA0(Boo)e215B09..lapeenastm.cam EPA Form 8700-22A(Rev.Me) Previous editions are obsolete. <br />GENERATOR COPY <br />UNIFORM HAZARDOUS <br />Generator's US EPA ID No. Manifest Document No. <br />22, Page <br />Information in the shaded <br />WASTE MANIFEST <br />121. <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 Generators I <br />24. Transporter Company Name 25. US EPA ID Number <br />N. State Transporter's ID <br />O. Transporter's Phone <br />26. Transporter Company Name 27. US EPA ID Number <br />P. State Transporters ID <br />O. Transporter's 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 />r-H—MI <br />No. Type <br />Quantity <br />WWoI <br />a. <br />b. <br />ti JLi <br />C. <br />... ,- <br />r <br />G <br />d. <br />E <br />N <br />E <br />R <br />A <br />e. <br />T <br />O <br />R <br />f. <br />9 <br />It. <br />i. <br />S. Additional Descriptions J?r M0.fjplg.L,i§ted Above - -- <br />T. Handling Codes for Wastes Listed Above <br />32. Special Handling Instructions and Additional Information <br />T <br />33. Transporter _ Acknowledgement of Receipt of Materials <br />Date <br />R <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />N <br />5 <br />P <br />34. Transporter _ Acknowledgement of Receipt of Materials <br />Date <br />R <br />PrintedlTyped Name <br />Signature <br />Month Day Year <br />E <br />R <br />A <br />35. Discrepancy Indication Space <br />c <br />L <br />I <br />T <br />Y <br />Style CF to LABELAAsTFA0(Boo)e215B09..lapeenastm.cam EPA Form 8700-22A(Rev.Me) Previous editions are obsolete. <br />GENERATOR COPY <br />