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Please print or Form desi ned for use on elite 12- itch owliter. <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23. tffe"stTrackingForm A ved.OMIT No.2050-0039 <br /> {Continuation Sheet) �+... � <br /> 24.Generator's Name (i <br /> C\S 3 <br /> 25.Transporter Company Name U.S.EPA ID Number <br /> 26.Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers <br /> HM and Packing Group(if any)) 29.Total 30.Unit 31 Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> LK <br /> c0� y <br /> all <br /> 2 <br /> w <br /> c� <br /> r <br /> 32.Special Handling Instructions and Additional Information <br /> w 33.Tr er Ar3Cnowie anent of Recei of MateriNs <br /> F Printed/Typed Name <br /> Signatu <br /> AAonrr Day Year <br /> Z 34.Trans er_ Acknowled ent of of Materials <br /> Printedll'yped Name k <br /> Ck <br /> > 35.Discrepancy `� 1 <br /> _J <br /> V <br /> U- <br /> 0 <br /> W <br /> z36.Hazardous Waste Report Mangement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and <br /> t) recycling systems) <br /> rn <br /> LU <br /> 4 <br /> EPA Form 8700-22A(Rev.3-11 05) Pre11 vious editions are obsoiete. <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />