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Please Print or Form desi ned for use on elite72 tch ter, form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.GeneratorlD Number 22.Pae 23.Manifest Tracking Number <br /> (Continuation Sheet) � � mo <br /> 3 <br /> 24,Generator's Name <br /> 113 t3�lZ Co 1 C1 <br /> 25.Transporter -�s Company Name U.S EPA ID Number <br /> U.S.EPA ID Number <br /> 26.Transporter Company Name <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(rf any)) No. Type Quantity Wt./Vol. <br /> O <br /> W <br /> Z <br /> W <br /> C7 <br /> 32.Special Handling Instructions and Additional Information <br /> Acknowled mentof Receipt of Materials <br /> transporter <br /> s /Typed Name ignai Month Day Year l <br /> Z 34.Transporter Acknowled ment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> r <br /> 35.Discrepancy <br /> J_ <br /> V <br /> Q <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> C7 <br /> fn <br /> W <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />