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Please print or Noe. ffcrm designed fnr ncp nn Flitp <br />:FA Form 6100-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />- "' ' <br />21. Generator ID Number <br />22, Page <br />Form Approved. OMB No. 2050-1039 <br />23. Manifest <br />(Contlnuatlon Sheet) <br />CA2890090002 <br />5 <br />Tracking Number <br />006370331 J.iK <br />2d Generators Name IL -,3 Mf?rira Lhfa7Tl0f_ h!1 P)n31 L3bOr'ai0r f `.it2 '! for PIGlSA. may <br />Li <br />verrore CA. 34551 <br />25 Transporter�AN 14 gig <br />Company Name U.S. EPA ID Number <br />26. Transporter Company Name US EPA ID Numbe i. <br />HEALTH Di-ER",RTMENT <br />71,irid <br />27b. U S. DOT Description (including Proper Shipping Name, Hazard Class, ID Plumber, <br />28, Contaicers <br />Parking Group (if any)) <br />29 Telal <br />29 Tol y <br />30. Unit <br />30.�it Unit <br />31 'Waste Codes <br />No. <br />Type <br />35. Pion-IRCRA hazardous v,raste, solid (bum Pit aft) (S.J95-2554) <br />1s1 <br />1 <br />DF <br />105 <br />P <br />38. Non-RCRA hazardous ,taste, Mid (debris contarninated V -4th <br />petroleum hydrocarbons)(nOP0044-1) <br />223 <br />1 <br />DM <br />80 <br />P <br />37. Non-RCRA hazardous v,raste, solid (debris contaminated Yv1th <br />petroleum hydrocarbons) (DOP0044-1) <br />223 <br />3 <br />DH <br />559 <br />P <br />0 <br />38. IZ!on RCPA hazardous waste, solid (dried paint) (D <br />--- <br />231 <br />w <br />o <br />DF <br />943 <br />P <br />39. Non-RCRA hazardous caste, solid (empty drum last contain <br />re!T0!aum hydrocarbons) (DOa0047-1) <br />s12 <br />I <br />DM <br />90 <br />P <br />40. `Jon-RCRA hazardous vvaste, solid (errpty drum last contained <br />petroleum hydrocarbons) (DOP01347-1) <br />sit <br />1 <br />DM <br />40 <br />P <br />41. Non-RCP.A hazardous •:vaste, solid (emor; dl- contained <br />petro!eumh;'drecar�bcns� nn -1) <br />( P0047 <br />_12 <br />7 <br />DM <br />333 <br />P <br />42. Non-RCP.A hazardous wvaste, solid (empty dr -um) (DOP0047-11 <br />s13 <br />1 Lit <br />1 <br />16 <br />P <br />43. Non- RCRA hazardous vvaste, soiid (errpC,f drums last contained <br />;:etrclejl h; drecarbons) (OOP0047-1) <br />512 <br />2 <br />D14 <br />80 <br />P <br />44 Mon-RCRA hazardous•,Jaste, _olid (greasel (DGF0037-11 <br />'221 <br />1 <br />Dt1 <br />1'73 <br />P <br />32 Special Handling Instructions and Additional Information <br />33 Transporter Acknardedgment o1 Receipt of Materials <br />LU <br />Printed/Typed Name Signature Month Day Year <br />c <br />0 <br />a <br />Z <br />34. Transporter _ Acknordedgment of Receipt of Materials <br />PrntpdTyped Name Signature Monlh Day Year <br />F— <br />} <br />35 Discrepancy <br />N <br />J <br />U <br />Q <br />LL <br />O <br />W <br />a <br />36 Hazardous Waste Report Management Method Codes (i e., codes for hazardous waste treatment, disposal, and recycling systems) <br />Z <br />0 <br />U) <br />U, <br />0 <br />:FA Form 6100-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />