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Please print or type. Form designed for use on elite 2-pitch)typewriter.) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121-GeneralarlD Number 22.Pa0 1 ge 23.Manifest Tracking Number <br /> (Continuation Sheet) Cow 13Con(,pQ5 <br /> 24.Generator's Name t419 V11 <br /> 25.Transporter--2�— Company Name <br /> 26. Transporter Company Name U.S.EPA ED Number CV7 <br /> /f�T ✓Jd3 <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 WtNol. <br /> i <br /> O <br /> W <br /> Z <br /> W <br /> t.7 <br /> i <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter 2 Acknowledgment of Receipt of Materials <br /> �4n.WdffyMS' re M Year <br /> arans Acknawled mentof Receipt of Materials <br /> al <br /> PrinledfT Name Signature ant ay ear <br /> 35.Discrepancy <br /> _J <br /> V <br /> a <br /> 0 <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> C9 <br /> w <br /> a <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />