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Please print or type. Form Approved. OMB No. 2050-0039
<br /> UNIFORM HAZARDOUS WASTE MANIFEST 121 , Generator ID Number 22. Page 23, Manifest Tracking Number
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<br /> 24. Generator's Name = ( )•' P a sL. ;' C f w . a r_. l / '
<br /> 25, Transporter Company Name U.S. EPA ID Number
<br /> 26, Transporter Company Name U .S, EPA ID Number
<br /> 273. 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 31 . Waste Codes
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<br /> 32. Speaat Haridling Instructions and Additional Information x (,1 d , r F r. , € ' ' 9 44
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<br /> 33- Transporter Acknowledgment of Receipt of Materials
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<br /> Z 34. Transporter AcknoWed ment of Receipt of Materials
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<br /> 35. Discrepancy
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<br /> Q38 Hazardous Wgste Report Management Method CBd s,(i. . , codes for hazardous waste treatment disl9osal, and recycling systems) u
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<br /> EPA Form 8700-22A (Rev, 12"17) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR
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