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PleasePrint or type. Form designed for useon elite V2-pitch) eWriter. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 Generator ID Number 22 Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generators Name <br /> � <br /> rc J t [c`�ic `.���s .� c <br /> S. <br /> 25. Transporter Company Name U. EPA ID Number <br /> 26. Transporter Company Name U.S.EPAID umber 1 <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30,Unit 31.Waste Codes { <br /> HM and Packing Group(i(any)) No. Type Quantity Wt.Nol: <br /> } <br /> i <br /> CO <br /> K <br /> w <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter edgmem of Receipt of Materials <br /> w Printadfryped Name Signature Month pay Year <br /> �� 1 <br /> d _ iG7 <br /> Z 34.Tw oder AcwoMedq4u!mQfRGc4fqfMatra. <br /> PdntedrFyped Name o1gramure Month Day Year <br /> 35.Discrepancy <br /> J <br /> U <br /> LL <br /> D <br /> 36.HazwousMgt6 Repprt Management Method Codes p e codes for hazardous writs treatment,disposal,and recycling systems) <br /> F <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY M GENERATOR <br />