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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generators Nam <br /> 25. Transporter C parry Na a -�'� <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name U.S.EPA ID Num r <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,ID Number, 2B.Containers 29,Total 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 31.Waste Codes <br /> 1 <br /> C <br /> W <br /> Z <br /> W <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of aterials <br /> LLJ Prirtedfryped off Signet Month Day Year <br /> O y <br /> C1. <br /> U) <br /> 34.Trensparter Ad nowled ment of Ficeipt of Materials <br /> Printedrryped Name Signature Month Day Year <br /> F <br /> 35.Discrepancy <br /> J_ <br /> U <br /> rai <br /> 0 <br /> W <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> C7 <br /> in <br /> W <br /> G <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO EPA's e-MANIFEST SYSTEM <br />