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Please print or type. Form Aooroved, 0MB No. 2050- 1 " GENERATOR I UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. Generator ID Number <br />6A cog ', 16 1-/ Di) <br />22, Page <br />.P-, <br />23. Manifest Tracking Number <br />(91,9incirr5 2-04 "2 <br />Generators Name <br />Obc4, _Zper-- <br />Transporter 3 Company Name U.S. EPA ID Number <br />.06.4914.'" brig-Asy /4-"CiZ I A.00 to941--"2. ) gsePS,c-r'- <br />U.S. EPA ID Number Transporter Company Name <br />I <br />27a. 27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 28. Containers 29. Total 30. Unit 31. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt.Nol. <br />Special Handling Instructions and Additional Information TRANSPORTER Transporter _,.../ Acknowledgment of Receipt of Materials <br />Printed/Typed Name Signature Month Day Year <br />c..,444. Jor.... I I 1 )9 Ps2 ....... <br />Transporter Acknowledgment of Receipt of Materials <br />Printed/Typed Name Signature Month Day Year <br />I I I I I DESIGNATED FACILITY Discrepancy <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />I I I I <br />I I I I <br />EPA Form 8700-22A (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM