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Please print or type. Form designed for use on eliteJMNumber <br /> iter. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) 00 d,a/�5a y 00 36 C71,5 fir^ <br /> 24.Generator's Name <br /> 25. Transporter Company Name f� U.SS..EPAIDNumber <br /> 27�v/ /• <br /> 26. Transporter Company Name U.S.EPA ID Number <br /> 27a. 271b.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 /> O <br /> H <br /> Q <br /> w <br /> Z <br /> w <br /> c� <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> w Printed/Typed Name Signature 9 Month Day Year <br /> a � <br /> co 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name ignature Month Day Year <br /> F— <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL. <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 /> 0 <br /> y <br /> w <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />