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Please print or Form desr red for use an elite 12 pitcW t ewnter Form Approved OMB No 2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST21 Generator ID Number 22 Page 23 Manifest Tracking Number <br /> (ConUnuatlon Sheet) 2 f Z 2 Q �7 ✓ �"" <br /> 24 Gene atces Name C �S®vi S+ O f/}� T) `- i vZ C. <br /> 2 <br /> us EPA ID Number <br /> 25 Transporter Company Name <br /> U cPA ID Number <br /> 26 Transporter Company Name ` 6-Y] <br /> o Q 0-7 <br /> 27a 27b U$ DOT Descnpbon(including Proper shipping Name,Hazard Class,ID Number, 28 Containers 29 Tota; 30 Unit 31 Waste Codes <br /> HM and Packing Group(d any)) No Type QLantdy Wt Not <br /> � t <br /> O <br /> W <br /> Z \ <br /> W \V <br /> � r <br /> 32 Special Handling Instructions and Additional Information <br /> 33 Transporter S Acknowledgment of Receipt of Materials <br /> ear <br /> Prntedayped Name s gam° Month Day v <br /> 0 a Lo eZ 9 l a <br /> z 34 Trans rtes Acknowledgment of Receipt of Materials <br /> Prmted!'ypedNTe /�� (/�} gnature o y e/ar <br /> 35 Discrepancy <br /> J <br /> U <br /> 6 <br /> u. <br /> O <br /> Q36 Hazardous Waste Report hlanagemerd Method Codes(i a,des for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> t9 <br /> m <br /> W <br /> Q <br /> EPA Form 8700-22A(Rev 3-05) Previous editions are obsolete DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 160938-114918-2 <br />