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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121,Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.GeneratorsName 11,\C t(,L,v <br /> �A-0LX t-0 <br /> 25. Transporter Company Name U.S.EP�At ID Number <br /> 26. Transporter Company Name <br /> U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 2g.Total 30.Unit <br /> HM and Packing Group(if any)) 31.Waste Codes <br /> No. Type Quantity Wt./Vol. <br /> ;k j <br /> t `tom`�5�° " J 1 9a I ?G L21 <br /> 0 <br /> a - <br /> w <br /> z <br /> w <br /> c� <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> tw— Printed(Typed Name Signature Month Day Year <br /> O <br /> a <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed(Typed Name Signature Month Day Year <br /> t— <br /> 35.Discrepancy <br /> J_ <br /> V <br /> LQL <br /> w <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> c9 <br /> c <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO EPA's e-MANIFEST SYSTEM <br />