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w f <br /> Please print or type.(Form designed for use on elite 12- itch)tvpewriter3 Form Approved OMB No.205CM39 <br /> UlgFORM HAZARDOUS WASTE MANIFEST 21 Generator ID Number 27 Paae 23.Manifest Tracking Number <br /> (Continuation Sheet) C. a 1 �,�1( ( ( ( {S L ,� 7 1L <br /> Ls. s , t `v �� <br /> 24 Generator's Name <br /> LL tJrr ', L { elCit� r4*4 <br /> iter <br /> US EPA ID Number <br /> 25 Transporter_� Company Name <br /> 26 Transporter _ Company Name <br /> U S.EPA ID Number <br /> 27a. 27b U.S DOT Description(including Proper Shjpping Name,Hazard Crass.ID Number 29.Containers 29.Total 30 Unit 31 1Vasle Codes <br /> HM and Packing Group(d any'1 No. Type Ouantity Wtivol <br /> O i <br /> Q <br /> tr <br /> LU <br /> 11.1 <br /> C9 <br /> r <br /> i <br /> i <br /> 32 Special Hand,;ng Instructions and Additional Information <br /> 33 Trensoorter - Acknovde men!of Receipt of Materials <br /> F PrintectTyped Name $,fir q 6S Day Ybm <br /> a <br /> Z 34 Transporter Ackno'a'iedcment of Receipt of Materia!s <br /> < Pnnted+iyped Name SqMft Kibnth Day Year <br /> F <br /> 35 Discrepancy <br /> i� <br /> Q <br /> C <br /> a36 Hazardous Waste Report Management Method Codes(i,e codes(cr hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> t.7 <br /> in <br /> LU <br /> G <br /> EPA Form 8740-22A(Rev.3-051 Previous editions are obsolete DESIGNATED FACILITY TO GENERATOR <br />