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I � <br /> `t l <br /> Please Drint or type, Form dssi ned for use on ofite 12- Itch writor. Form Approved.OMB No.2050-00,9 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Genaralcr ID Number 22,Pa g 23.Maulfest hacking Number <br /> (Continuation Sheet) P fl !7 d I a(� li (� U c�V C�Y U-Z s," jig <br /> 24.Generator's Name <br /> c�� <br /> I <br /> 26.TrarapoRer CcmU.S.EPA ID Numoerpany.Vame r <br /> Cl G�"1 Lrjrn af5 1U l) ��( va yrs YL-t 6.3-, LZ.Z S d <br /> 26.Tmrsportor CcrlpanyName U.S,EPA IDNumber <br /> i <br /> I <br /> 27a. 27b.U.S.DOT Desalptlon(including Proper Shipping Name,Hazard Class,ID Number, 28.C©nlalnors 29.Total 30.Unit <br /> NM and Packing Group(It any)) No. Type Quentity WIJ`dol. 31,Waste Coles <br /> I <br /> I <br /> i <br /> i <br /> I <br /> 0 <br /> a i <br /> � 2 <br /> i C7 <br /> I , <br /> I <br /> I <br /> I <br /> I � <br /> I � <br /> . Ijfi <br /> i <br /> 1 <br /> F <br /> 'I <br /> f <br /> I I <br /> . 1 <br /> 1 <br /> 32,Spatial Handling Instructions and Addltronal Information <br /> i <br /> i <br /> i <br /> it <br /> a 33.Transporter Acknoowl mant of Recel f of klalarlals <br /> H Printed/lypadName Signature <br /> Mont) Day Year <br /> 0 y Y' t.c_1 L �r�_ `" _ ,o Z(1 <br /> Z A Trans onor Ackrowlod rant of Receiat of Materials <br /> Printedlfypad Nama gnah raMonth 11ay r <br /> F- <br /> 35.Dlsaepancy <br /> I <br /> � II <br /> 0 <br /> 4 36.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste trofitmont,disposal end racyGing systei a) <br /> z I <br /> � I <br /> w <br /> p <br /> EPA Form 5700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRE } <br /> I I <br />