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i <br />Please print or type. Form designed for use on eifte (12=pitch) typewriter• Form Approved. OMB No. 2050-0039. <br />EPAForrfr A (Rev. 3.05). Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />UNIFORM HAZARDOUS WASTE: MANIFEST <br />.2t. G.gneat� 14 Number: y` a+ rx` r w <br />1. 22, Papa <br />23. Mardfeat T IPS yynrgr <br />(Continuation Sheet) <br />Za. Generators Name <br />C (; Y{ +"+1 (i;r.;rr r f+�:• f �i <br />/ <br />U.S. MD Number <br />25. Transporter S Company Name J- ; '1 <br />r <br />U,S.'EPA ID Numbet <br />26. Transporter Company Name <br />27a. <br />27b. U.S. DOT Description Qncluding Proper Shipping Name Hazard Class; ID Number. . ' +u <br />28. Containers„ <br />291Totit -. <br />30: U <br />. -"^ <br />HM <br />raridPwwrEg 6[ IFeayj}�� _N--, _ :.:?mow =k : ,.. S t .-. .: - <br />° <br />,3f.�{I(asta <br />__ .-77.. <br />y:''. <br />No. _ <br />uaiitity` <br />wq <br />Ul <br />Z <br />-4J F. + y y ' `• .E .,; H» ?!4l?f <br />':H� ..p <br />-.r .ry.r <br />.. <br />' •T:lr�•c 2'Y:rtT rY�-'!%L� „ry%�..-i•. i i•kl'N. „'G•.! �.S^.. z� � • • _ r: iR..f .: <br />.:5.<>; iF <br />S "A <br />r-r':iRJ <br />Cf7'� <br />,fr+nnn►' 4 <br />-. .:.�. <br />ji <br />=;;'?4Y'''nFy:'3;�r!�';ix�:••'•R: Y•vio. at"Fs�nk�;�.;erc.^w•-, _ <br />, •- ;:.r:- <br />- P'. <br />wry <br />. <br />J <br />.. <br />..yil.').: `x't �. _} <br />-77 77 <br />.-9:.—..r6....•1••' <br />32. Special Handing Instructions and Additional Informatim <br />33. TransportewAcimowledgment ofRecelpt of Materiels <br />H <br />PrinteCyped Name Signature j Month Day Year <br />CL <br />tr% <br />_34,. �r4adgnent:of Receipt a(Matedala .. .-_. - = - ..; - .,4. _... _ -• T . - . _ <br />PnntedirTyped Name Signature Math Day Year <br />F- <br />35. Discrepancy <br />V <br />LL <br />O' <br />38. Hazardous Waste Report Management Method Codes q.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />C9 <br />eo <br />W <br />O <br />EPAForrfr A (Rev. 3.05). Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />