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' d titin Approved.OMB Nc.2050°°49. <br /> "".-yRfees�pr tootype.: (Form designed for <br /> r <br /> nelite ,rRch)typewriter.) `URIFORM HAZARDOUS Generator's US EPA ID No. Manifest Document No 22. Information in the shadedareas isnot required by Federal <br /> WASTE MANIFEST aw. <br /> (Continuation Sheet) � G _ ` <br /> L.State Manifest Document Number <br /> 23.Generators Name <br /> M.State Generator's ID' <br /> 24.Transporter '9 Company Name 25.US EPA ID Number O.Transporters Phone <br /> N.State Transporters ID - , <br /> S i;•' <br /> 26.Transporter Company Name 27 US EPA ID Number .. P.State I ransporters ID <br /> Transporters Phone <br /> 29.Containers Total Unit Waste No <br /> 28.US DOT Description(in duding Proper Shlpping Name,Hazard Class,and ID Number) No. Type Quantity WWoI <br /> a. <br /> b. <br /> IFTHE IMAGE DISPLAYED IS <br /> NOT AS LEGIBLE AS THIS <br /> C. OVERLAY,IT IS LIKELY DUE <br /> TO THE POOR QUALITY OF THE <br /> ORIGINAL DOCUMENTS/IMAGE. <br /> ° d. <br /> E <br /> N <br /> E <br /> R <br /> T <br /> R <br /> I. <br /> 9 <br /> h. <br /> i. <br /> T.Handling Codes for Wastes,Listed Above <br /> S.Additional Descriptions for Materials Listed Above <br /> 32.Special Handling Instructions and Additional Information <br /> Date <br /> T 33. Transporter — Acknowledgement of Receipt of Materials onth Day Year <br /> R Signature <br /> 4 Printedl7yped Name <br /> N <br /> e j Date <br /> 0 34. Transporter 4 Acknowledgement of Receipt of Materials Signature <br /> a'� month Day Year <br /> E —printed/Typed Name <br /> F 35. Discrepancy Indication Space <br /> P <br /> L <br /> Y ,.,�� EP�F>T e10622/.IPer.9-eel�wious e0111Me wa oOrdeR <br /> style CF to ®reaois' FILE COPY OR STATE COPY <br />