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Please print or type. <br /> UNIFORM HAZARDOUS WASTE MANIFE57 21.Generator ID Number Farm Approved.OMB No.2050-0039 <br /> Page 23.Manifest FIm i III Number <br /> (Continuation Sheet) 0 P V 3� 2-z O G � ,� L �D.��ry Q <br /> 24.Generators Name / / j rj�� <br /> 25. Transporter—�— Company Name U.S.EPA fD Number <br /> om r - T 7` Q 17 S <br /> 26. Transporter Company Name U.S.EPA i0 Number <br /> 27a. 27b.U.S.DOT Description ��(including Proper Snipping Name,Hazard Class,ID Number, 28.Containers <br /> HM and Packing Group(if any)) 29.Total 30.Unit <br /> No. Type Quantity Wt-Not. 31.Waste Codes <br /> 4 <br /> O <br /> cY <br /> IN <br /> Z <br /> W <br /> C7 0 <br /> i <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> F Printed/Typed Name Signature <br /> Month Day Year <br /> 34.7ranspoder Acknowiedgment of Receipt of Materials <br /> "z) z0 <br /> Prmtedrryped Name Si re <br /> 11— 1 i l 1 1 <br /> Month Day Year <br /> 35.Discrepancy S <br /> ai <br /> U <br /> a <br /> L <br /> LU <br /> a 36 Hazardous Waste Report Management Meihod Codes(i.e.,codes for hazardous waste treatment,disposal,and recyding systems) <br /> Z <br /> c7 <br /> U) <br /> w <br /> v <br /> EPA Form 8700-22A(Rev_12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />