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Please print or type. Form designed for use on elite 12 itch typewriter.) Form Approved.OMB No.2050.0039 <br /> ¢ UNIFORM HAZARDOUS WASTE MANIFEST 121.,Generator ID Number 22.Pa/g�e 23.Manifest Tracking Number — <br /> I <br /> (Conti Sheet) k` b �' �� � 1 1 <br /> 24.Generator's Name <br /> l U.S.EPA IID NNuu,m}ber <br /> 25.Transporter Company Name�r c i y ctn c "� 1 <br /> U.S.EPA ID Number <br /> 26.Transporter Company Name <br /> 279, 27b.U.S.DOT Doscription(Including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. I Type Quantity WI.Arol. <br /> a <br /> O <br /> W ZiZ <br /> xW <br /> W <br /> u <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Tran er Acknowledgment of Receipt of Materials <br /> nla <br /> S Month Day Year <br /> o <br /> a <br /> ll <br /> rn 34.Trans er —Acknowledgment of Recet t of Matedals <br /> Prinled7ryped Name Signature Month Day ear <br /> 35.Discrepancy <br /> v <br /> L<1 <br /> 'I <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> C9 <br /> W <br /> EPA Form 8700.22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />