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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21•Generator IDDNNju b �� 22.P� 23.Manifest Tracking Number <br /> (Continuation Sheet) �6A cam! /� s� <br /> 24.Generators Name / <br /> 25.Transporter_ Company Name U.S.EPA ID Number <br /> In -5° l" tG6�� xoq /�4 •�— <br /> 26.Transporter Company Name <br /> U.S.EPA ID Number <br /> 27a, 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29,Total 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 31.Waste Codes <br /> w � <br /> z - <br /> w <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transpo-(jej__Cjt'r"'AcknowledgmeM of R=ipt of Matedgts <br /> F Print lure Morph Day Year <br /> Z 34,Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name II Signature Month Day Year <br /> 35.Discrepancy <br /> _J <br /> U <br /> a <br /> LL <br /> O <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems){ <br /> 0 1 1 1 1 <br /> y <br /> W II 11 <br /> C3 1 ( 1 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED) <br />