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Please print or pe.(Form designed for use on elite(12 itch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) G' k. <br /> 24.Generator's Name <br /> `�� <br /> 25. Transporter Company Name U.S EPA ID Number <br /> Yi S f��.�•.� S <br /> 26. TransporterCompany Name ( I ©V I� ii1 i 1 � r D u b 6 U Vi" <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,(Hazard Class,IO Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(0 any) No. Type Quantity Wt✓vol. 31.Waste Codes <br /> i <br /> i <br /> i <br /> I <br /> a <br /> Q I <br /> cc IW <br /> i I <br /> i <br /> I <br /> i <br /> 32.Special Handling instructions and Additional Information <br /> ¢ 33.Trans orte> Acknowledgment of Receipt of Materials <br /> H Printe d Name �,/� i Signatu Month Day Year <br /> f 44 <br /> Z 34.Tr sorter Acknoeried ment of Receipt of Materials <br /> Printedlfyped Name ` f Signature �fgryti Qay r <br /> } 35.Discrepancy <br /> f— <br /> v <br /> LL <br /> O <br /> a36,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal and recycling systems) <br /> Z <br /> cS <br /> rn <br /> w <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />