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I <br /> Pfease print or type.(Form desiqned for Use on elite(12-pitch)linewriter.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24 Generator's Name <br /> 25. Transporter Company Narne U.S.EPA ID Number <br /> 26.Transporter Company Name I 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 Wtivol. 31.Waste Codes <br /> J.I!*,, RE Rn 11..1._'af-UC4} t:a�fi'_. � k�r!'a'' t� ir_,'it.^t' ly ^JU 'i5 Ir 3:? <br /> Pt rJULf <br /> f <br /> Oa <br /> a 1 <br /> w I <br /> z <br /> LU <br /> c� <br /> _ kk <br /> 32.Special Handling Instructions and AdotorW Information <br /> t.QD- La�'l_i1 <br /> .r. <br /> 33.Transporter Ackrywiecigmeni of Receipt of Materials <br /> us I.— <br /> Printedrryped Name Signature Month Year <br /> ix <br /> I 1 1 1 <br /> 34.Transporter AckruMedament of Receipt of Materials <br /> Printedrryped Name Signature Month Day Year <br /> 35.Discrepancy <br /> J <br /> LL <br /> 0 <br /> Q36.Hazard Was a Re Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> c� <br /> EPA Form 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGRATED FACILITY TO GENERATOR STATE(IF REQUIRED) <br />