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Form Approved.OW No.2050-0038 <br /> Jnr (Form designed for use on elite 12 'Ich) er.) a 23.Menffeet Trachfng Num r <br /> UNIFORM HAZARDOUS WASTE tdfANIFEST 21.Garr 'or*Number `J <br /> (Continuation Sheet) <br /> 24,Ganerator's Name <br /> U.S.EPA ID Number <br /> 25.Transports pa armr Gu <br /> °4 <br /> U,S.APAIDNIbr <br /> 26.?rang Company Name i <br /> 278. 27b,U.S.DOT Description(Including Proper Shipping Name,Hurd Class,ID Number, 28.Containers 28.Total 30.Unit 31.Waste Codes <br /> HM Packing Van0) No. Type Quantity Wt,Abl, <br /> ' I <br /> . I <br /> I <br /> i <br /> tz <br /> c� <br /> I <br /> i <br /> I <br /> I <br /> t. <br /> 32.Speaal HarWflrg Instructim and Additional Intomffidon <br /> i <br /> i <br /> 33,T iter Adnowladamerill ofR�Of Materials Month Day Year <br /> Prin No Signature E <br /> t�l(1,iIRE <br /> 34.T Adaimle ntof Recelplof fulatenela <br /> Pd—Typed Nerve Signature Mangr Day Year <br /> 36.DlscrePanu3' <br /> r <br /> 4 <br /> Q36,Hazardous Waste Report Management Method Codes(i,e„codes for hazardous waste treatment,disposal,and rec fig systems) I^ <br /> z <br /> c? <br /> i <br /> EPA Foran 8700-22A(Rev.3.05) Previous editions are obsolete, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />