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IL <br /> Please print or type Form desfgned:for use an elite(I 2-pit6h)1yoiawnter} <br /> Form,4pprxiveii,OMB No:2D544Q39 <br /> UNIFORM HAZARDOUSWRST� 9N(Fi 2t Generator-ID Nwnber 1 22.Page. 23.Manifest Tracidng,Numbei <br /> ::{CohNglration 5fteet}_� :, -_ <br /> 24,Generator's Name <br /> 25.Transporter Company Name <br /> U.S.FPA ID Number <br /> f � U.ti EPAIDNamber <br /> 26.Transporter E , Company Name •", , r �� , ' r ... <br /> � �f- � ? 'i � 4�3'�' ft'• �..� e� �� � �:��f �1 p �SLf`�..� f } S �.L'% �U�{. � r�•�=. <br /> 27a. 27b.U.S.DOT Description(including Proper SHpp4g Name,Hazard pass,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM. and PacMpg Group{flanY)l._ ._ No.:._ •. <br /> T/pe. Quantdjn Wt IVoI. <br /> p � <br /> r <br /> UJI <br /> v- <br /> Za <br /> ..- — <br /> 32.-'SpeciaI Handlirig Instructions and Additional lnformdtion . <br /> 33.Transporter Acknmyled mentof Receipt or Matorkds - <br /> Prfnted/Typed Name Signature Month Day W,,v <br /> 34.Transporter i_- Ackrtowl m of Receipt of Materials <br /> PrinWTyped Name Signature ' << Mwtli Day Year t' <br /> X Discrepancy <br /> Q <br /> 36.Hazardous:Waste Report Marrdggemeut Methogppdes{i.e.,codes iadtazardoys waste treatment.disposal;and-tecycirg'syawrms} " <br /> a i <br /> LU <br /> EPA arm ,22A(Rev R.5) Previous edfions are obsolete. GENERATOR'S fNRIAL�COPY. <br />