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Please pant or'ype (Farm deslgned for use on elite('12-'p'itc'h lt <br /> UNIFORM.HAZARDOUS WASTEUWFEST 21 Generator IR Number FOrt <br /> 22 Page23:Manifest nifest Treeking,Num6er <br /> Appmved.OMB No.205"039 <br /> - •,,�CoratlrluaSton�tge�}.- '' '- _ ' <br /> ?a:Generator's Name, <br /> .. .. ..-. <br /> 23.Transporter Company Name <br /> U.S;EPA ID Number r. <br /> 26.Transporter company Name }'_t r .',, ; _ ` U 5 yEQI ib Numhar ". <br /> VA <br /> 2Ta. 27b.U.S.DOT Description(including Proper Stripping Name,Hazard Class,ID Number, 26.Containers <br /> HM• and Paddgg Group{puny)) 29 Total 30.Unit .31.WasteCodesNo. ....,Typo._ Quentitp. WLN91. <br /> . . ..cry n. ,F.-.. . .� -•g -,.a r. . .. - - <br /> Uj <br /> - <br /> a <br /> 4' <br /> -•..... _ <br /> 32:'Specia[K dliiiglnstrx1fodsendAddilionellnforma6on a <br /> 33.Transpo W AcknoWed ment of Receipt of Materials — <br /> i�l Pt nteQlTyped Now Signelue Month Day Year. <br /> 14 <br /> j.=. <br /> 33� 34.Transporter i_• Admow nt of Receipt of Materials <br /> PrintedifypedName' <br /> SigneWre�~ Month -Day Year <br /> 35.Discrepancy <br /> a <br /> . ;i <br /> 36 Hazardous:Waste Report Managemedt Method Cedes(ie.,codes for-hazardoyswasta trestment.dleposa)shd tecyeHng systems} <br /> • <br /> rn - <br /> . . ly r - <br /> F. EPA nrm -22A(Rev.-3-05)_Previous edltiona are obsolete. GEN&ATOWS`INMAL•7COPY. <br /> J, <br />