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Please print or type. <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFESM21. erator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) Qap 3 93 7d O 77o i��.$KS <br /> 24.Generator's Name �s_ _ ` � p .�+.►t ex-"/-f"ti �:.�,aa <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> Clean Harb+ars Env Svcs Inc MAD039322250 <br /> 26. Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers <br /> HM and Packing Group(if any)) 29.Total 30.Unit 31.Waste Codes <br /> No. Type Quantity wt./Vol. <br /> r <br /> I <br /> 1 <br /> I ` <br /> t <br /> w <br /> w _ M <br /> C7 <br /> T <br /> ) <br /> i <br /> d <br /> 4 <br /> I <br /> s <br /> i <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter r-Acknowledgment of Receipt of Materials <br /> F Printed/Typed Name <br /> 0 Signature Month Day Year <br /> a <br /> ThomasClark noI z 1 o 4 <br /> 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature <br /> Month Day Year <br /> 35.Discrepancy <br /> V <br /> 0 <br /> w <br /> a 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> C7 <br /> LU <br /> LU <br /> o <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. FAC IIJT .P)Pks , k <br />