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aesicined for use on elite 12-pitch) ewriter. Form Approved.OMB No.2050-0039 <br /> L vrFc zM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22,Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> 25. Transporter Company Name US.EPA ID Number <br /> 26. Transporter Company Name .S.EPA 10 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)) 31.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> t 1 <br /> r <br /> W i <br /> Z " <br /> W <br /> C7 _ <br /> _ -- - _�-'• - i f �..... Lir- C`. I _ ..�._ .�._...._.e <br /> —' ..f <br /> =1 <br /> 32.Special Handling Instructions and Additional Information <br /> 1 - ca.S - <br /> j � ! <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> F Printed(Typed Name Signature Month Day Year <br /> O <br /> a <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> F— <br /> 35.Discrepancy <br /> J_ <br /> C) <br /> LL <br /> G <br /> W <br /> a 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> coW <br /> D <br /> i <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. _ DESIGNATED FACILITY TO GENERATOR <br />