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Plane print or type. (Form designed for use on elhe(12-pitch)"writer.) Form Approved.OMB No.z So 00.99. <br /> UNIFQRMHAZAEiQlQUS '21 Generators US EPA ID No. Manifest Document No. 22 Peg Information in the shaded <br /> WASTE MANIFEST3/ areas is not required by Federal <br /> (Continuation Sheet_) � �/li3/�3J—U3� (D7`1 (P 3 law. <br /> 23.Generator's Name s •'S t �` .".'� oc u e•-'"' ": <br /> 24.Transporter C mpany Name 25.US EPA I Number <br /> 26.Transporter Company Name 27.US EPA ID Numbers <br /> 29.Containers 30W <br /> i <br /> 31E st-fi <br /> 28.US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Total Unt ' <br /> �„ - No. TV,): Quantity WtIvol <br /> ?M) <br /> n. <br /> C. pr <br /> Rol <br /> d M' _ <br /> E <br /> E 1 tom- C7txV`_. <br /> R a <br /> s w <br /> A e. <br /> Lotim S�'K3 << <br /> g, W- sm <br /> h. <br /> i., <br /> t S„-�-i'A2•�' •.11. ��a�2^l � wY, `..vR+r.3Y.�MM����A~�� �1` SKS� �.xS...� +�is�;- iyeA�i <br /> 32.Special Handling Instructions and Additional Information - <br /> T 33. Transporter _'Acknowledgement of Receipt of Materials Date <br /> A Printed/Typed Name - . Signature - onth Day Year <br /> N . <br /> s <br /> P 34. Transporter._ Acknowledgement of Receipt of Materials - - - Date <br /> EE Pr(nted(fyped Narne• - - Signature Month Day. Year <br /> - R <br /> a'135. Discrepancy Indication Space - - <br /> - �.: - <br /> r <br /> T _ - <br />