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Please print or type.(Form designed for tae on Hite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.QBneratortD Nulmber 22.Page 23.Manifest Tracking hi mbar <br /> (Continu/alio/n Sheet) \�. _�l_ J�ZC j�" (4.�' � 1�J � <br /> 2a.ca,eiatoraName <br /> l� <br /> U.S.EPA IDNomber <br /> 25. Transpotar_ Company Name <br /> 26. Transporter_--1— Company Name U.S.EPA ID Number <br /> 27a, 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, - 28.Containers 29.Total 30.Unit <br /> HM and Padtlng GouP('rf any)) No. Type <br /> Quantity Wt.Nol. 31.Waste Codes <br /> w � <br /> w <br /> i <br /> 32.Speaal Handling Instructions and Additional lnramnat n <br /> 33.T _L_ mentot MMaterials <br /> O PrinteMyped Name ` �� Signs bxe _ Month�� DaY t Vear <br /> rl <br /> = 34.Tm of RaceIptokilawals <br /> Prinle0yped Name Signature, Month Day year <br /> r <br /> ( <br /> 35.Discrepancy <br /> V <br /> LL <br /> D <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardap waste treatment,disposal,and racyclirg systems) <br /> z <br /> CD <br /> W <br /> D <br /> EPA Form 8700.22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACIA ITY TO GENERATOR <br />