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Please print or tvpe. Form designed for use on elite 12- itch ewriter. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> PC> "—b <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> U.S.EPA ID Number <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 WLNoI. <br /> I <br /> C>r <br /> 0 <br /> w <br /> Z <br /> w <br /> C7 <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter =Acknowledgment of Receipt of Materials <br /> Lu PrintedlTyped Name �1 Sign Month Day Year <br /> Z 34.Transporter Admow ed ment of Receipt of Materials <br /> Printedfryped Name Signature Month Day Year <br /> F <br /> 35.Discrepancy <br /> J <br /> U <br /> a <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 /> LU <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />