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Please print or type, Form designed for use on elite(12-pitch)typewriter.) 611502193689-001 SC PPW 6/16/2015 Form Approved.OMB No,2050-OC <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheen ICAL000284823 2 of 2 008301191FLE <br /> 24,Generator's Name <br /> PAQ Inc DBA Rancho San Miguel <br /> U.S.EPA ID Number <br /> 25. Transporter Company Name <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> X 5. UN1791,WASTE HYPOCHLORITE SOLUTIONS,8, PQ II P P D002 <br /> 122 <br /> 6. 111110 STE 89RRr <br /> JN <br /> r lNGRe r <br /> 0 8. NON RCRA HAZARDOUS WASTE LIQUIDS,(SOAP, DETERGENT) <br /> DI/� <br /> - /DO 331 <br /> w <br /> z <br /> w I <br /> a <br /> 1 <br /> �p <br /> .SeH�I0 Inform <br /> 7--"1 Q Q f i 9 � <br /> 8.CH1007275 <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> H Printed/Typed Name Signature Month Day Yei <br /> O <br /> a <br /> z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month ay e; <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> C <br /> � 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and,�cycling systems) <br /> Z 5. H040 6-NA4A—�-,-PT ��.�� S. H040 <br /> U) <br /> LU <br /> 0 <br /> EP6"fl � (R�s tti�4f*B*f64WW�9l,5Nnd will accept the waste the generator is gRQ.ED FACILITY TO DESTINATION STATE(IF REQUIR <br />