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Please print or type.(Form designed for use on elite(12-oitchI tvoewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST =t utra5or t0 ffum{at f �� agr ,rAni#eas iraddng ttuet <br /> (CgntinualtonSheet} �h ! /* <br /> ( I mrfc d K' •7 � <br /> 24.Generator's Name <br /> 25. Tr3mporrr ^_ N <br /> 26. Transporter_ _Company Name <br /> 273. 27b.U.S.DOC Description(including Proper Shipping game,Hazard Class,10 Numhar, it (tt 28.Cantainers 29.Total 30.Unil <br /> HM and Packing Group(if am) No. Type duantily2 yyt gyral, 31.Waste Codes <br /> i <br /> i <br /> w <br /> W III <br /> W <br /> f I <br /> r ' <br /> i <br /> i <br /> i <br /> 32.Special Handling Instructions and Additional Information <br /> pC Arknnwir.d9mrnt nt Receiat of Materials' _ <br /> w Pdnted/ryped Name 1 <br /> Signature Month Day Year <br /> --� ,� -r. : ► <br /> Z 34.Transporter , Ackwoledament of Receipt of Materials .e <br /> Printed/Typed Nami f c_ Signature himrth Day Ye- <br /> ��,(�I��f /7/fL. <br /> } 35.Discrepancy <br /> u <br /> V <br /> IL <br /> In <br /> Q36.Hazardous Waste Report Management wthod Codes(i.e.,codes for hazardous waste treatment,disposal and recycling systems) <br /> W <br /> I ! I I <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. <br />