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V0r type.(Form designed for use oweille(11-pitch)typewriter, o Form Approved.0 flo.2050.0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1,21, ra _ID Num er f r+ 22,Pae 23.Manire atki g.NN b <br /> (Conkinuation Sheet) >�+ f 1 <br /> 24,, eperelors Name �.�,: / %t2✓Y �., /�,�-�''` '' ' <br /> 25,•Tranhpoder—�— Company Name ��II <br /> fU.S.EPA'V Number <br /> 7 J cH N �Ci� <br /> 8,Transporter mpany' rpe. , U.S. PA ID Number <br /> •27a. Y7b.,UZVIT Description(including ProperShipping Nanfo zard d6ss.ID Number, .2&Containers 2g,'Tolal 30,Unit <br /> Packing , <br /> HM and Group(I any)) No, Type Quantity,+ MA+el, 31,waste Codes' <br /> LU <br /> r • • <br /> • • iia <br /> / <br /> 32„Spedal Handing Instructions and Addlllanal Information. '„• <br /> 33.Transporter ment iptorMateda <br /> �u Printeryped ma f�,�► 51 reg” M t Y ar <br /> ca <br /> 34.Transporle • •Acknowlad merifol Receipt of Matorrals r <br /> Printed/Typed Nave -, I Slgnalure 'Month Day Year <br /> 35.Discreeponoy <br /> Q36.Hazardous waste QW.Management Method Codes(i.e.,aortas for hazardous waste treatment,disposal,and recycling systems) -� <br /> EPA Form 8700-22A(I;ev.3-05)'Previouseditionsare pbsolete, DESIGNATED FACIL.ITYTO GENERATOR STATE VF'RtgiUIRED) ' h, <br /> .` 13116.0960 _ '` <br />