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Please riot or e. form desl ned for use on elite 12- itch ewritee <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number Form A roved.OMB No.2050-0039 <br /> 22.Page 23.Manliest Tracking Number <br /> (Continuation Sheet) 78,79 2:10 <br /> 24.Generators Name $ r TracyCotRmunW'Hos 2 t}11 E, <br /> 1420 N Trac BIW • ' d`. <br /> Tracy,GA 95376•. ;.. <br /> 25.Transporter Company Name U.S.EPA ID Number <br /> 26.Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Descripption(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers <br /> HM and Packing Group(11 any) 29.Total 30.Unit <br /> No. Type Quantity W Hol. 31.Waste Codes <br /> UNi993,.lAfeste-RatnntaW611gUidfi,n-®-s:(ETH ALC <br /> X ISOPROPANop,3,N 242 DD�1 <br /> 1 f Sf` <br /> UN2811 1 h9b To*scift.orgenic,n.®S.(NICOTINE; <br /> X 1A81RFARit�,6.1,R .,> Mol P075 <br /> p <br /> UNI,M,AeroSigl&,Pt;3tSt]N <br /> X 1 OF P 311: <br /> p UN1993,,,MWtp Flatntnahle 114UIds,n,o,s.(4040WNE, <br /> r X RD - L),3.II, 213 DWi Do18 <br /> 1 Z P , <br /> W <br /> 32.Special Handling Instructions and Additional Information <br /> 5}877497 E. ..... 'b�872153, ER(MI54 T)877482 E i B 8)238.736.ERtW128 <br /> u55 l 1t� /X5; c5 <br /> M 33.Transporter_Acknowledgment of Recei t of Materials <br /> LU O Printed/Typed Name Signature <br /> Month Day Year <br /> a <br /> Z 34.Transporter_Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature <br /> Month Day Year <br /> 35.Discrepancy y <br /> J <br /> Q <br /> 0 <br /> U, 36. a eport Management Metho d odes for hWrdou�Jia <br /> ystems) <br /> Z <br /> M <br /> uu <br /> D <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />