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Please print or type. Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21. enerator lD ber 22. PagQ 23. n'rfest Tracking Number _ <br /> (Continuation Sheet) �f��/j/ <br /> 24.Generators Name <br /> 25. Transporter` Company Name U.S.EPA ID Number <br /> 7- o � li <br /> 26. Transporter Company Name U.5.EPA ID Number <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(if any)) No Type Duancty, Wt Nal. <br /> I <br /> 1 � <br /> i I <br /> K <br /> H <br /> W <br /> W I <br /> e7 $ <br /> I <br /> I <br /> I <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acelowredqnneci Percept Materials <br /> w Pdnted7yped Name Signature Month Day Year <br /> K OJ fl♦ /. <br /> O <br /> a <br /> z XTransporter Acknowled ment of Recei t of Matedals <br /> Printed/Typed Name Signature Month 5a—y ear <br /> F <br /> 35.Discrepancy <br /> J_ <br /> V <br /> Q <br /> LL <br /> L] <br /> W <br /> Q 36.Hazardous Waste Repel Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> O <br /> rn <br /> w <br /> O <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />