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Please print or type. Form designed for use on elite 12- itch typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) C b 1 <br /> 24.Generator's Name <br /> 25. Transporter I Compame - U.S.EPA ID Number <br /> rI C I V� b sib -)w c) t ' <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 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> I <br /> i <br /> ) <br /> f <br /> w <br /> M <br /> LU <br /> 32.Special Handling Instructions and Additional Information <br /> W 33.Transporter Acknowledgment of Receipt of Materials <br /> F Printed/Typed Name '/ Signature Month Day Year <br /> 114 <br /> a r <br /> - 111 11� 11Z <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> } 35.Discrepancy <br /> J_ <br /> V <br /> Q <br /> LL <br /> G <br /> W <br /> a 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> c7 <br /> U) <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STA`E(IF REQUIRED) <br />