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Please print or type, Form designed for use on elite12• itch typewriter.) Form Approved. OMB No. 2050.0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1 21. GeneratorlD Number 22, Page23. Manifest Tracking Number <br /> (continuation Sheet) C f�( [�CXj $ Z 'wL C( 2 Z ' Z 7jS <br /> 24, Generators Name <br /> Ccul%41 o+- ,��'-rjjj;Y+ RC" S i � 3 tCJ ` r �t r Ove CLa �$3 <br /> Loci COA 4.!52- leU <br /> 25. Transporter, , _ Company Name <br /> U.S. ID,Number 'Lz <br /> wo t boot fm I ff 600 IOU ' ov <br /> 26. Transporter Company Name U.S.IlA10tuber (J <br /> 27a. 27b. U.S. OOT Descrfplion (including Proper Shipping Name, Hazard Class, 10 Number, 28. Containers 29. Total 30. Unit <br /> HM and Packing Group (it any) No. Type Guantity WtNol. 31 . Wasle Co las <br /> a <br /> 0 <br /> w <br /> Z <br /> w <br /> I <br /> 1 <br /> 32: Special Handling Instructions and Additional Information <br /> 33. Trans oder - LAcknowledgment of Receipt of Materials <br /> PdnteditypedName Signature Month Day Year <br /> y 34. Transporter ' Acknowledgment of Receipt of Materials <br /> Pdnled/ryped Nama r, Signature Month Day 'Yea' <br /> rpit nA n 1117AV11 Ll 12 IN I <br /> 35. Discrepancy <br /> i <br /> a <br /> 96,Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste t(eatment, disposal and recycling systems) <br /> W <br /> 0 <br /> EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. EPA's e-MANIFEST SYSTEM <br /> DESIGNATED FACILITYTO <br />