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t: <br /> .(Form designed for use on elite 12-pitch)typewriter.) Form Approved.OMB No.20500039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.ticn rartta lD�Numbey_h I� 22.Pa� 2S.MenHast 7a'<b\ln bar ;O� <br /> (Continuation Shaat) v ' 1 �(J(/! V��"m 7 <br /> za.Genambra llama <br /> �s "� J u.s,EPA lU Na70 <br /> 25.Transponer^(._Company Name q V �((l/.6 <br /> 28.Tumspuner�Cpmpany Name 4/7 S.EPA ID Number <br /> t tv/ ✓Ori lLAILf <br /> 27,, 27b,U.S,00T0esalption(indudinq Proper Snipping Name.Hazard Ctj In Number, 20.Contalnars 29.TOral 30.Unit 3I.Wash Codes <br /> HM and P3*n9Group(dany)) No, Type Quantity WINot <br /> 0.' <br /> Oa <br /> K <br /> w <br /> ou <br /> w <br /> 32,Spedal Kandil rg Instrocfions and Add,Wnal Information <br /> 33.Transpodar A mento( Dl of Male' <br /> W PdnledlT9ped Name Signalu Man 'Z3Day Year <br /> O-' <br /> N <br /> Z 34.Tmnsporler Admowl men Rewipl of Mat pals <br /> Pmu Nana Anatum Month Day Your <br /> a TO <br /> 35,Olscrepancy <br /> J <br /> V <br /> Q <br /> LL <br /> 36.HauNous Waste Report Management Method Codes(1-8.codes for ha:artlaus wash treatment disposal,and recycling systems) <br /> ...?ZA(Rev.105) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />