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Please print or type. Form designed for use on elite 12-pitch)typewriter.) 611502193689-001 SC PPW 6/3.6/2015 Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) CAL 0 0 0 2 8 4 8 2 3 2 of 2 1 ON30IMFLE <br /> 24.Generator's Name <br /> PAQ Inc DBA Rancho San Miguel <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> 26. Transporter_ Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(inducing Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(if any)) 31.Waste Codes <br /> No. Type Quanti4, wt./Vol. <br /> U 791,NtASTE BY LO. SOLUTIONS,8,PG ll.,'. DQ02 <br /> X° `t <br /> 122. <br /> WWI <br /> y <br /> UN- <br /> 0 S.:NON RCRAA HAZARDOUS WASTE LIQUIDS,(SOAP,DETERGENT) <br /> 331 <br /> w <br /> aS al�8'd7 $ uctiors an a n6 154 <br /> 7 <br /> 8 067275 f � N�A <br /> [Y 33.Tranorter Acknowle meat of Receipt of Materials <br /> FW- Printed/Typed Name Signature <br /> OMonth Day Year <br /> 0. <br /> co 34.Transporter <br /> Acknowledgment of Receipt of Matenals <br /> Printed/Typed Name ignatum <br /> F- Month ay ear <br /> 35.Discrepancy <br /> F- <br /> J <br /> U <br /> Q <br /> LL <br /> O <br /> W <br /> r— 36.Hazardous Waste Report Management Method es(i.e.,codes for.hazardous waste treatmen disposal,-an cyc i�systems) _ <br /> z- 5.H04tY __.. _ <br /> 0 r— 8. H040 <br /> UJ <br /> W <br /> 0 <br /> 1V0P ' *W10*1eand will accept the Waste the generator isDsF ED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />