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Pleacp nrint nr tvne iPnrm rtoainneri fnr uce nn elite f 12-nitnhl tvnnwriter 1 <br />Form Aooroved. OMB No. 2050-0039 <br />EPA Form 8700-22A (Rev. 3-05) Previous Editions are obsolete. 1G° <br />UNIFORM HAZARDOUS WASTE MANIFEST erator r 22. Pae 23, anlfest Ticking er <br />(Continuation Sheet) <br />24. Gene•stor's Name +� <br />1 <br />26. Transporter Company Name U.3. EPA ID Number <br />Ne.�\ O�-i . < � <br />27a. <br />HM <br />27b. U.S. DOT Description (including Proper Shipping Name Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Containers <br />r). Total <br />Quantity <br />36. Unit <br />WL/Vol. <br />31. Waste Codes <br />No. <br />Type <br />0. <br />w <br />� <br />z <br />w <br />32. Special Handling Instructions and Additicnal Information <br />w <br />0CL <br />V) <br />33. Trans e r Acknowledgment of Receipt of Materials Y -- <br />Pnn IT ee Signature IMonnttthh/I �Dsy Year <br />34. Transporter Acknowledgment of Receipt of Materials <br />P' 1TypadName ignature �.r�c day Year <br />c 61r <br />r <br />H <br />J <br />U <br />Q <br />0 <br />35. Discrepancy <br />W <br />Q <br />36. Hazardous Waste Repos Management Method Codes (i.e., codes for hazardous waste treatment, dspo:;al, and recycling systems) <br />rn <br />LU <br />O <br />n117e71Ll eTlnul CTNTC IX DCr1t IIr7Gnl <br />EPA Form 8700-22A (Rev. 3-05) Previous Editions are obsolete. 1G° <br />