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,ase print or type. (Farm designed for use on eli itch) typewriter.} <br />- Farm Approved, OMB No. 2050-0039. <br />UNIFORM HAZARDOUS 21. Ge ,or's US EPA ID No. <br />Manifest Document No.=Informationshaded <br />WASTE MANIFEST <br />(Continuation Sheet) <br />ed by Federal <br />23. Generator's Name <br />APP11ea I11tBrospace 3-crucrures, Corp, <br />3437 S. Airport <br />L. State Manifest Doc menIt ber <br />Way, P.O. Box 6189 <br />Stockton, CA 95206 <br />M- State Generator's 1D <br />24. Transporter 9 CompanyName 25. US EPA ID Number <br />�f <br />EF36 5__380`r <br />N. State Transporters iD <br />26. Transporter 10 Company Name0 <br />27. US EPA ID Number <br />Transporter's Phone - <br />P. State Transporter's ID <br />0. Transporter's Phone <br />28. US DOT Description (Including Proper shipping Name, Hazard Class, and ID Number 28. Containers 30. 31. R. <br />} Total Unit <br />a• No. <br />Waste No. <br />T pe Ouantit Wt1Vol - <br />PS f <br />b. �w <br />`r�FJ}Vmay/ r�iei�rJ� <br />Pc41 <br />x1 17 rGrli'1 Af116 's w ifs. Awre ri -50iuprvl �jP' / <br />q-11 uN 1961?) %z <br />P l <br />E d' trpAR15�4' �� L $� �.(�.5� C�Ift�MrC QG <br />W <br />bmR' <br />S� U N 1 1 <br />R 76a PC IC <br />j <br />P <br />001 <br />e. <br />!3F 000Q0 <br />A j <br />T �Ur Ij.O.�� C►T� C�I�dr; 1 <br />FA sin 9, /u#3, PCI <br />IJu�If <br />1 r <br />bm X5'1 <br />�a <br />x fie, 8L.4"'jf► A1�l UJUP73 / <br />/ 3 / a p4 �r .�C C� 1} � � <br />b°° <br />� 353 <br />9 -kb <br />/,�e`/� <br />ort <br />M0 <br />h, <br />f. <br />i <br />S. gAAd��ditional Descriptions for Materials Listed Above i ro, ' <br />7 �✓4. �!' �b. 005 7� ` vc- Q RSIR �`j,, � Iq� T Han odes f law <7qI <br />�1/!�a <br />Handling Instructions and Additional Information <br />TSL Printer irfi 111VOiCO: Premier Chemical <br />24 Baur Emergency Phone _Number: Chemtrec (800) 535-5035 <br />T 33. Transporter _4 Acknowledgement of Receipt of Materials <br />R <br />A Prinied/Typed NameDate <br />s Signature onth Day Year <br />P <br />0 34. Transporter Acknowledgement of Receipt of Materials <br />R <br />T Printed/Typed Name Date <br />R Signature onth Day Year <br />A 35. Discrepancy Indication Space <br />C <br />1 <br />L <br />1 <br />T <br />Y <br />Style CF 18 04(8W)fi21-5x08 wwW,kLbekna$t@r.r <br />,0M- <br />EPA Form 8700-22A (Rev. 9-88) Previous editions are obsolete. <br />—�rnwrsna�A€craF1W ORIGINAL -RETURN TO GENERATOR <br />