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` r Form Annroved.DMB No.2050-0039 <br /> Pleas rint or ty2e, Form designed for use on elite 12 itch ewriter. 22 Pa��' M�OM <br /> umber <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number �(Continuation Sheet) IC (J``" <br /> 24.Generators Name <br /> U. EPA I N rp <br /> 25.Transporter CampanyName �� f <br /> U.S.EPA ID Number <br /> 26.Transposer Company Name �es v�b <br /> 27a. 27b,U.S.COT 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.1voi, <br /> i <br /> i <br /> i <br /> Oix <br /> ,�s._...,.- <br /> a s <br /> LLJ <br /> PC <br /> E <br /> I <br /> f <br /> } <br /> S <br /> i <br /> 32.Special Handling Instructions and AddiGonai Information <br /> 33.Trans rier Acknowle ment of Receipt of Materials Moy e <br /> S' tur (() <br /> dfiyped <br /> LU 4 <br /> 0.' Cry <br /> O <br /> 0. <br /> Z34.Trans oser AcknnwAed ment of Recei i of Materials Month Day Year <br /> ign <br /> < Printedn-yped Name 8 k71 <br /> 35,Discrepancy let <br /> J_ <br /> V <br /> Q <br /> 11. <br /> D <br /> Q36 Hazardous Waste Report Management Method Codes(i.e.,oodestor hazardous waste treatment,disposal,and recycling systems <br /> Z <br /> C) <br /> U) <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> EPA Form 8700-22A(Rev.3-05) previous editions are obsolete. <br />