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t. <br /> Please rint or e. Form designed for use on elite 12 it6j.. ewriter. ` Form A roved.OMB No.2050-0039 <br /> _F. <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Pae ' 23 Manifest Tracking Number, <br /> g g <br /> (Continuation Sheet) r' <br /> 24.Generator's Name <br /> 12 <br /> U.S.EPA ID Number <br /> 25. Transporter Company Name ,F <br /> U.S.EPA ID Number <br /> 26. Transporter. Company Name <br /> '` s :yam i€,_ .,a .:,� '. v.z w' �' " «.,tY., it - <br /> t <br /> b._ _ .� 4� <... w .� _ ,,.� -..,• ms.µ ... �;. <br /> 27a. 27b.U.st 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 /> R <br /> Uj <br /> 3 <br /> { }` <br /> uJ t <br /> s <br /> .F <br /> i <br /> 9y:. <br /> r <br /> 32.Special Handling Instructions and Additional Information <br /> 33,Transporter f Acknowled ment of Recei t of Materials <br /> w Printed/Typed Name Signature Month Day Year,: <br /> CL <br /> 34.Trans iter Acknowled ment of Receipt of Materials <br /> Pdnted/Typed,Name ignature RontF Year <br /> t r <br /> r a F <br /> 35.Discrepancy <br /> F— <br /> J <br /> a _ <br /> LL <br /> 4 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> � r <br /> LU <br /> EPAF6-rm`8'700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />