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1.3iosi <br /> Plea* rint 4.r, e. Form deSi ned for use on ell itch ewnter Form Approved.OMB Mo.2850-0039.Expires 930-96 <br /> P : ?YP 9 P )tyP ). 41 <br /> UNIFORM HAZARDOUS 21.Generator's US EPA ID No. Manifest Document No. 22.Page Information in the shaded <br /> WASTE MANIFEST ureas is not required by Federal <br /> .(Continuation Sheet) IC R D 4 3 4 6 42 9 0 a $ 0 2 1 2 o _ law. <br /> 23.Generator s Name L ��ir € St Dtutnent NWtnt�e! ; <br /> DMAXNf 10 �� <br /> X029 $ T$ ST <br /> T G. <br /> CA 95240 t rat�r�sJ� <br /> 20.9-333-3500 &MMUNd CWTLCTs <br /> 24.Transporter Company Name 25.US EPA ID Number tittaeTanporte a'ID <br /> MNl MAS ZXMSS14JM986601380 <br /> 26.Transporter Company Name 27.US EPA ID Number PState ftspbtter' 1D„ <br /> 29.Containers 30. 31 <br /> 28.US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Total Unit as iUe <br /> HM No. Type QuantityWtIV 4 <br /> s. <br /> a. <br /> t <br /> b. <br /> C. <br /> E <br /> R <br /> T �a <br /> Rq. � � x <br /> €yam <br /> h. s ' . <br /> I. �' p3F, <br /> ^ a . <br /> x, <br /> 32.Special Handling Instructions and Additional Information RM AppROMATR pt02I+CTIVR GWM MM >AWMIM <br /> �,�s @@gy�p� 2 �. * 1-800-424-9300. ., - <br /> ST I . .T11r SROW= � <br /> 11A. VA39533, 11BD 0133-VA02 = <br /> T 33. Transporter _ Acknowledgement of Receipt of Materials Date <br /> R Printed/Typed Name Signature Month Day Year <br /> N , <br /> P 34. Transporter e Acknowledgement of Receipt of Materials' Date <br /> R Printed/Typed Name Signature Month Day Year <br /> A 35. Discrepancy Indication Space <br /> C <br /> 1 <br /> L <br /> 1 <br /> T <br /> Y <br /> Style CF18-6 Labeimaster,An American_Labeimark Co.,Chicago,IL 60646 (800)621-5808 EPA Form 8700.22A(Rev.9-88)Previous editions are obsolete. <br /> WAnkPRKM0NRe7Y tavuM DT[DNOT TSDF COPY <br /> uslasoymm p7t 11VIC- <br />