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Please Drint or type.Form designed for use on elite 12•itch ewriter... _..: .. Form Approved.OMB No.2D5D-0039 , <br /> UNIFORM HAZARDOUS WASTE MANIFESTG ralorl[yJumtler _ � 22.Pa nifeslT k Nu <br /> (Continuation Sheet) U/V'VVT <br /> 24,Geoeatols Nalme <br /> F <br /> 25.transporter Company Na" 5. ION ben G <br /> 1. <br /> 26.Transporter Company Name _ U.S.EPP.fD Number C� <br /> 27a, 27b.U.S.DOT Description Including PrcperStipping Name,Hazard Class,10 Number, - 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) -No. Typo' Quantity WLIV011 <br /> t <br /> LU <br /> CD <br /> a <br /> K <br /> w <br /> z <br /> ( <br /> 32.Special Handling Instructions and Additnai Information - <br /> 0 <br /> 13.TromporterAckEQentofReolptofMaWials - N `— <br /> Uj <br /> rin dRyped ane Sig .,. onlh Day Year <br /> 110 j <br /> CL <br /> z 34.Transporter Acknow!22aTent of Receipt of Materials - S <br /> P tedriyped NamMonth Day ear <br /> 35.Disc panty <br /> W <br /> a 36.Hazardous Waste Report Managernent.Melhod Codes(i.e.,codes.far hazerdouswasle treatment,d'aposal,and recycling systems) .... ... <br /> ul <br /> w <br /> O <br /> EPA Form 8700-22A(Rev.3.05)Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> o <br />