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Please print or tvoe_ (Form designed for imp nn plitp /19-nitrhl tvnpwritpr l <br />;nm Annrn—el rVJA Nn 9n{n11n" <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />121 Generator 10 Number <br />l ^: c 0-j 7 y3.rt,. <br />22. Page <br />'1 P ? <br />23, Manifest Tracking Number <br />(rf1 J•}� ih t <br />24. Generator's Name <br />Della Grnci al ''17f. -irk <br />25. Transporter Company Name U.S. EPA ID Number <br />26. Transporter Company Name U.S. EPA ID Number <br />27a. <br />HM <br />27b. U.S DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Containers <br />29. Total <br />Quantity <br />30. Unit <br />WtJVoL <br />31. Waste Codes <br />No. <br />Type <br />5. 14Lj 11 ('.I'F.A h -A I Li 0 L S, :'."S_tCS 11tH (C L Ti a t t;:f f., r <br />L! <br />DF <br />0028 <br />P <br />131 <br />r=, Can El ct.• )a c- Tor I'C.:vc•1 inq fl— em-, �.l <br />3 <br />Dib <br />Go1'a'4 <br />F' <br />1B1 <br />0 <br />W <br />z <br />W <br />C7 <br />32.SpecialHandling Instructions and Additional Information i;0'.2' ,,:,nii-Rr 7P L is '_1sc, .!'! .0 (CR Dri vY <br />Rcc T,-.1 iiiq ) <br />33. Transporter Acknowledgment of Receipt of Materials . <br />H <br />IL <br />PrintedlTyped Name Signature Month Day Year <br />I 1 1 1 <br />Z <br />34, Transporter AcknoWedoment of Receipt of Materials <br />Printedliyped Name Sqnature Month Day Yiw <br />J <br />U <br />Q <br />W <br />G <br />35. Discrepancy <br />Q36. <br />Hazard3s Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />l Lli I� X11 I I <br />H <br />W <br />C3 <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR STATE IIF REQUIREDI <br />