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Please print or type.(Form designed for use on elite(12-pit0)typewriter.) Form Approved OMB No.2050-0039 <br /> 'iNiFORM HAZARDOUS <br /> io WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manliest Tracking Number <br /> {Continuation Sheet) <br /> 24.Generator's Name <br /> tl <br /> U.S.EPA ID Number <br /> 25. Transporter._ Company Name <br /> U.S.EPA 10 Number <br /> 26 Transporter Company Name <br /> 27a, 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Glass,ID Number, 28,Containers29.Total 3C.Unit 31,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt,[Vul <br /> O <br /> tY ' <br /> LU <br /> z <br /> LU <br /> rry <br /> 32,Special Handling Instructions and Additional Information <br /> 33,Transposer Acknowledgment of Receipl of Materials <br /> UJ Pnnled(Typed Name Signature Month Day Year <br /> O <br /> Z <br /> 34,Transporter Acknowledgment of Receipt of Materials <br /> PrintedfTyped Name Signature Mon{h Day Year <br /> t— <br /> r 35.Discrepancy <br /> J_ <br /> U <br /> a <br /> 0 <br /> a36.Hazardous Waste Report Management Method Codes{i.o.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> 0 <br /> Cn <br /> w <br /> 0 <br /> EPA Form 5700-22A(Rev 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />