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Please prlri or lube. Fera designed for use on e'iie;12^itch t ev�riter i Forza.Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121,Generator!DNumbor 22.Paye23.Manifest Tracking Number <br /> (Continuation Sheet) '$ <br /> 24.Generators Name <br /> U.S-EPA I Number <br /> 25. Transporter_ Company Name <br /> U.S.EP.A'D Number <br /> 26 Transporter Company Name <br /> 27a. 27b.U.S DOT Description(including Proper Shipping Name:Hazard Class,!D Number, 28.Containers29.Total 30_Unii 31,4Vasle Codes <br /> HM and Packing Group(if any)) No. Type Quantity WU/el. <br /> F.IYon L ,7i c11'-'ooft rite, _.:i1C1 !i JQnSf 111e�- � is {�{(`��-.:r'? - <br /> 4`i'r1 j uct.; . <br /> I <br /> i <br /> 0 - <br /> l <br /> IL <br /> W <br /> I <br /> I <br /> 1 <br /> 1I <br /> I <br /> 32.Special Handling In,ructions and Adc`onai information Zs. 1 10t) J t Nell- R S 3 i 1 Cf Waste (CA Only, It) <br /> "s3.Transtxn ter AeknoWedgment of Receipt of Materials <br /> H Pr7r16adlTyped Name Signature Month Day Year <br /> 0 <br /> a <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> pM Name .signature "Month Day Year <br /> � f 1 <br /> } 35.Discrepancy <br /> F- <br /> v <br /> 0 <br /> a36.Hazardous Waste Report Management t:":ethod Codes(l.e_,codes for hazardous waste treatment,disposal;and recycling systemsl <br /> LU <br /> LU <br /> EPA Form 8700-22A(Rev,3-051 Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />