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print ort e. Form designed for use on elite 12- itch typewriter.) <br />I HPlease <br />roves. umn No. �uou-uvay <br />ID N <br />121, Generator umer <br />UNIFORM HAZARDOUS WASTE MANIFEST� <br />22. Pagebg <br />23. Manifest Tracking Number <br />4Z Cl %I 9 <br />L <br />(Continuation Sheet) <br />24, Generator's Name <br />U.S. EPA ID Number <br />25. Transporter Co pany Namg - <br />J ' on <br />OQ� <br />' (� <br />XCI <br />U.S. EPA ID Number <br />26, Transporter Company Name <br />"i7 <br />/z <br />f 1 <br />3 <br />Q <br />l_V <br />c..i <br />27a. 27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID <br />Number, <br />28, Containers <br />29. Total 30. Unit <br />31. Waste Codes <br />HM and Packing Group (if any)) <br />No. <br />Type <br />Quantity Wtivol. <br />p <br />'S <br />u <br />1 <br />32. Special Handling Instructions and Additional Information <br />33. Trans der 66 Acknowledgment of Receipt of Materials <br />Signature <br />Month Day Year <br />ii <br />Printed[Typed Name <br />O <br />a <br />Z <br />34. Trans vier Acknowled ment of Receipt of Materials <br />naiur <br />Month Day Year <br />Print ped Name <br />35. D' crepancy <br />W <br />36, Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, <br />disposal, and <br />recycling systems) <br />to <br />W <br />v <br />DESIGNATED <br />STATE (IF REQUIRED <br />FACILITY TO DESTINATION ; <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. <br />