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Please print or type. Form designed for use on elite 12- itch t ewriter. 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.Generalor's Name <br /> 25. Transporter Company Name <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> U.S.EPA ID Number <br /> 27a. 27b.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)) <br /> No. Type Quantity WI.NoI. <br /> i <br /> -- ---- <br /> O <br /> Q <br /> W <br /> Z <br /> W <br /> (7 <br /> ----------- <br /> ------------- <br /> " f <br /> l <br /> i <br /> 32.Special Handling Instructions and Addilional Information <br /> 33.Transporter__Acknowledgment of Receipt of Materials <br /> LU H Printed/Typed Name Signature Month Day Year <br /> O <br /> a <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> < Printed(fyped Nam Signature Month Day Year <br /> I— <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> LU <br /> W <br /> 30.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> O <br /> rn <br /> W <br /> O <br /> EPA Form 8700.22A(Rev.3-05) Previous editions are obsolete. 4.:;:: „ else.;,.,,s Ah.ti,t-;.,E=.+vs n, ;.,.; ,,1.=::, GENERATOR'S INITIAL COPY <br />