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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 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> U.S.EPA ID Number <br /> 25. Transporter Company Name <br /> F. <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> ... ,. , _.. .,+ori! •d,. i�; , <br /> 27a. 271b.U.S.DOT Description(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. Type Quantity Wt./Z. <br /> 04 <br /> W <br /> Z <br /> W <br /> U <br /> i <br /> 32.Special Handling instructions aqd ditionaI Infor(nation i <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> H Printed/Typed Name Signature Month Day Year <br /> iY <br /> O <br /> a <br /> Z 34.Transporter _Acknowledgment of Receipt of Materials <br /> 9Printedrfyped Name Signature Month Day Year <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> L <br /> J <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> O <br /> U) <br /> W <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete,,. GENERATOR'S INITIAL COPY <br /> .,. .. <br /> 40Z4.2'*6. <br />