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Please print or type.(Form designed for use on elite(12 itch)typewritet Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Numb ar 22.Page 1-23.-Ma st Tracking Number <br /> (Continuation Sheet) <br /> 24.Generators Name <br /> Lc-f.rq o 5, (0/ <br /> 25.Transporter Company Name f� p U.S.EPA <br /> AIIDnNumber» <br /> r {F;�iat$.�iorty i .1 r }'l•..r ...1rlwtVlNO/ <br /> 26. Transporter Company Name �/—!'f/t C` —G ,J , / l 1 i`i\n f yt�/t17M <br /> MOu V�Vi'27a. 276.U.S.DOT Description(including Proper Shipping Name,�Hazarrdd Class,ID Number, ,/ V ' 28..Clontain'erH' and Packing Group(ifany) .Waste CodesNo. ii0'V I <br /> Q ' <br /> a <br /> cc i <br /> Z I I <br /> i <br /> i I <br /> I <br /> I <br /> i I <br /> I I <br /> r <br /> i <br /> i <br /> i I <br /> 32.Special Handling Instructions and Additional Information <br /> Q 33.Trans orter Acknowledgment of Receipt of Materials <br /> Printed d Namek v 1 Signatur Month Day Year <br /> or <br /> Z 34.Tisporter AAAcknowledgment of Recei t of Materials <br /> Prinled/TypedName Signature ry,,144 <br /> r <br /> 35.Discrepancy <br /> F— <br /> J <br /> U <br /> LL <br /> Q <br /> C36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal and recycling systems) <br /> Z <br /> C7 <br /> y <br /> W <br /> D <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />