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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Track/in umber <br /> (Continuation Sheet) (' �[�s,✓6 1 7 � e 3 65 �/6 <br /> 24.Genera oz's Name <br /> tea. ,k, a4- M�� �- 3 Q3- <br /> oao D <br /> U-S EPA ID Number <br /> 25. Transporter Company Name — _ <br /> l l „ -MOT) <br /> (!) o 2 O `r,9 <br /> US EPA ID Number <br /> 26.Transporter Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, 28 Containers 29.Total 30.Unit <br /> 31,Waste Codes <br /> HM and PacOg Group(if any)) No Type Quantity W1 Nol, <br /> t <br /> i <br /> I <br /> f j <br /> I <br /> r� <br /> Z <br /> W <br /> I <br /> s <br /> r <br /> I <br /> I f <br /> 1 i <br /> r <br /> i <br /> l <br /> I <br /> \ f i <br /> 32.Special Handling Instructions and Additional tMortration <br /> 33.Transporter Ackno%led ment of Receipt of Materials <br /> Month bay Year <br /> w ntedITyoed Name <br /> a <br /> oIJO 1009A <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> PrintedfTyped Name Signature Month Day Year <br /> F <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> amdisposal,36.Hazardous Waste Report Management Method Codes(i.e„codes far hazardous waste treatment, and recycling systems} <br /> Z <br /> t� <br /> W <br /> O <br /> EPA Farm 8700-22A(Rev,12-17) Previous ekons are obsolete. DESIGNATED FACILITYTO EPA's e-MANIFEST SYSTEM <br /> Page 21 <br />