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.(Fan designed for use on elle(12-pitch)typewrites) Fan Approved.OMB No.2050-0039 <br /> M HAZARDOUS WASTE MANIFEST 21.Ge^malar ID Number t' 22.Plage 23.Manifest Tacking Number -c <br /> (Conti uadon SheeQ <br /> yq.Ce^ealars Name <br /> U.S.EPAID Number <br /> 25.Transporter—�L Company Name L 3 <br /> s �1 <br /> U.S.EPA ID Number <br /> 26.Transporter_ Company Name <br /> Unit U <br /> 30. n <br /> . <br /> 21a. 27b.U.S.DOT Description Qnduding Proper Stopping Name,Hand Class,10 Number. 20Containers 29,Total 31.Waste Coders <br /> HM and Packing Group(d any)) - No. Type Quantity wt./Vol. <br /> j <br /> O <br /> Y Q <br /> W <br /> 2 <br /> W <br /> W <br /> LHandlingAdditonal Information <br /> C 33.Transpcder AclmmMed ntof Recei taf Matada1S Sre�tute Morita Day Year <br /> FW- PnnleMyped Name <br /> 34 Tan r_Acknowledgmenloffreoeiptof Materials Signature Month Day Year <br /> pdntedRyped Neme <br /> r <br /> 35.Discrepancy <br /> J <br /> V <br /> a <br /> LL <br /> D <br /> Q36.HarallousWasle ftepoM1Managemenl Mallod Codes(i.e.,codes far haratdous vmste treehnem,disposal,and recycling systems) <br /> V <br /> Oa <br /> W <br /> D <br /> EPA Form 8700-22A(Rev.3.005) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATpR STATE(IF REQUIRED) <br />