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Please print or tvoe, Form designed for use on elile 1 -pltr;b1 typewriter.) Form Approved.OMB No_2050-0039
<br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator l0 Number 22.Page Z 23.Manlfesi Tracking Number
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<br /> 24,Generators Name
<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.DDT Descri*n(including Proper Shipping Name,Hazard Class,ID Number, 26.Containers 29.Total 30.Unit
<br /> HM and Packing Group([any)) No. Type Quantity Wt.Nol. 31.Waste Codes
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<br /> a 33.Trans rt@r Acknowte meal of Reoe I of Materials
<br /> Printew Typed Name
<br /> � signature Month Day Year
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<br /> M 34.Trans rter Adorowlod meet of Reoet of lNatenais
<br /> Prin M Typed Name Signature onlb ay Year
<br /> 35-Dtscropancy
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<br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal.and recycling systems)
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<br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(1F REQUIRED)
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