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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 1 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> _Fj <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> 25.Transporter Company Name U.S.EPA ID Number <br /> 26. Transporter Company Name UT EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Vol. <br /> 31.Waste Codes <br /> i <br /> O <br /> w <br /> z <br /> LU <br /> (;9 <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> Lu Printed/Typed Name Signature Month Day Year <br /> ItO <br /> a <br /> U) 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> 35.Discrepancy <br /> _J <br /> Q <br /> J <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> 0 <br /> c <br /> LU <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />