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Plexe print or type. (Form designed for use one -pitch)typewriter.) Form Approved.OMB No.2050-0039. <br /> • UNIFORM HAZARDOUS 21.Generator's US EPA ID No. Manifest Document No. 22.Page Information in the shaded <br /> WASTE MANIFEST , Z. areas is not required by Federal <br /> (Continuation Sheet) law. <br /> 23.Generator's Name `j L.State Manifest(Document Number <br /> �•4/ J <br /> M.State Generator's ID <br /> 24.Transporter Company Name 25.US EPA ID Number N.State Transporter's ID <br /> O.Transporters Phone <br /> 26.Transporter Company Name 27.US EPA ID Number P.State Transporters ID <br /> Q.Transporter's Phone <br /> 29.Containers 30. 31. R. <br /> 28.US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Total Unit Waste No. <br /> —HM-1 No. Type Quantity WWol <br /> a. <br /> _ (.1 E} <br /> b. r_ ,1 _ :r_ zt-H z��>t::,;�., �;a��v� �:7G�:�9.YT..'s.•„P �':::� t30Cla <br /> _ <br /> C. <br /> G dg <br /> E345,"' !Y '7 <br /> r <br /> N n <br /> E T:. fly'. -4 13. TF 1 ?4'a,:•;flet"i.w.:`'i - .Y;:.:.. K ,t..t�.i nk ti _ r <br /> R <br /> A e. <br /> T +u.i , t 'Ct 1LLi:tt`i4° i!:3.'I fsii3i3Y{ '1'CrlCi <br /> R ➢ k ; <br /> 9• <br /> h. <br /> i. <br /> S.Additional Descriptions for Materials Listed Above T.Handling Codes for Wastes Listed Above <br /> a.r �� P�'�•�l't;s�.(:r[} ;r �Yrrs1� �,�t�-m� t`��f�r�r 1. � ., _� <br /> f.*kf.; t5' A'b br-ya ' ri (1,410f'3, "1 ' a <br /> 100 f t e-,*, f,i, t z l , t • s :" r� <br /> 32.'S0ebiai`Harid lirig1risirtictions and Additional Information <br /> b�YL�'�`tS.s.'k`ia t~�` ?:.. ..r.tr•. S-. ..�$kit'__. <br /> T 33. Transporter Acknowledgement of Receipt of Materials Date <br /> A Printed/Typed Name SignatureMonth Day Year <br /> N <br /> S <br /> P 34. Transporter Acknowledgement of Receipt of Materials Date <br /> R <br /> Printed/Typed Name Signature Wonth Day Year <br /> IF 35. Discrepancy Indication Space <br /> A <br /> c <br /> L <br /> T <br /> Y <br /> Style F16 LABELMASM O(800)621-5808 www.labelmaster.com EPA Form,8700-22A(Rev.9-88)Previous editions are obsolete. <br /> ®P.MO ON RECYU111 PMERr�PRINTfR WITN - <br /> usWGSOYBM1W 1 9= P:FNPRATnR C nPV <br />