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lease print or Form designed for use on elite 12 itch writer. Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 GWeratDr ID Number 22.Page 23. I t Tracking Number <br /> (Continuation Sheet) S <br /> 24,Generator's Name <br /> 25. Transporter 75— Company Name ` �� U.S.EPA Ip Number <br /> 26. Transporter Company Name U.S.EPA ID Number <br /> rs yr 8x�tl r s ri1 ,D �9 3�� Sb <br /> 27a. 27b U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 26.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(itany)) No. Type Quantity Wt.Nol. <br /> 3 <br /> r <br /> 4 <br /> 9 <br /> w <br /> Z <br /> LU <br /> i9 <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter wled ment of Receipt aftlatenals <br /> F PriniedlTyped N � Sig re Month �Day O Year <br /> O 'CJ <br /> CL <br /> 34.Transporter _Adwledgment of Receipt of Materials <br /> Prinleeyped ame Sign Month Day Year <br /> a -Ci " SID I Fill 117 <br /> } 35.Discrepancy IJ <br /> J <br /> V <br /> a <br /> v <br /> a36.Hazardous Waste Report Management Meftrod Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> to <br /> rn <br /> w <br /> v <br /> EPA Form 6700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />