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Please plinl or Form designed for use on elite 12 itch writer. Form Appmved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST tar I u 22.Pae nt c ' Number <br /> (Continuation Sheet) <br /> 24.Generators Name <br /> 25.Transport Company Name ILAAI U.S.EPA ID Number <br /> c�3Kq <br /> U.S,EPA ID Number <br /> 26. Transporter Com an ame <br /> '�.ft ' rS VW611013 Zzz�o <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 M.Nol. <br /> tr <br /> O <br /> W <br /> UJ <br /> 12 <br /> 32.Special Handling Instructions and Additional Information <br /> fr 33.Transporter Acknowled ment of Receipt of Materials <br /> F PrintedlTyped NauE �f Signa wMonth Day Ye <br /> o !•LrJ 22 <br /> CL <br /> z 34.Transporterrnenl of Receipt of Materials <br /> Printedfryped Name Si�gnature Monoay Year <br /> e4 1.ZaaA..l 6 3 V-;:11/ 'B <br /> 35.Discrepancy <br /> J <br /> U <br /> a <br /> v <br /> a36.Hazardous Waste Report Management Method Codes(i.e.,corks for hazardous waste treatment,disposat,and recAiN systems) <br /> Z <br /> f7 <br /> W <br /> O <br /> EPA Farm 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />