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Please print or type. Form Approved OMB No.2050-0039 <br /> DORM HA4RgOUP KASTE MANIFEST rator ID Nur&ei 22.Page 23,Manifest Tracking Number <br /> (Continuation Sheen <br /> 24.Generators Name <br /> Gallbn&NN"P*dlx.$ <br /> 1250 E.Le o. Road ashipw.aminemp-u m <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(Including Proper Shipping Name.Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(ii any)} No. Type Quantity Wt.Nol. 31.Waste Codes <br /> 5)UMM.WWD JorM.€ &IkW.beide..inp1park n.B.S. 591 b01112 <br /> X (Sodk=1-10OWds.Cak M 1-1100 de}.$,PQN pf' P <br /> 6)UM 326,WMIR ROM sands,OtOnk.n.O.S.(Snt kIM 661 D00 <br /> X L&WO sib,Ilcihlatsel Chaet904,4.1 .PON , r* ' P <br /> 7)UN2670,Waits lCadenk n wIrlipounds,6.1 ,POM 661 <br /> � 1 DF �V <br /> OCR— <br /> t P <br /> 0 8)UNI671,Wbste Ph&ewl.solid,B,1 ,M 561 Ui <br /> C) X l OF -j P - <br /> W <br /> z <br /> 9)UN&M.Cccr"lw soltd,addle,lewWnk,nos.(2hc <br /> X Ciel AN8,C..UPric Edi ).a.POD DF �V. P 561 <br /> 1110)UN3096 W11111ste Toxic elands,04dllift egos.{P+o11R SkM <br /> 1( P <br /> DlGht>ar ntat.6.1 (6.11.PdI 557 [)00 it <br /> X 11)UNMO.Totic,04",Organlc,n.os.(Thn001111i1111111ts, <br /> W►MOMM),ILI ,POO � •� �� <br /> r <br /> 12)UN1479,YV nb OIMn6 solid,Woos,PotURt Inn Iodate, <br /> S�iwr l+blrel S.1 P� DF ILI P 561 Doo Wil <br /> r <br /> t <br /> 32.Special Handling Instructions and Additional Informs <br /> S)ERGa154; XTWA& �O ERW33; AC Ts046e 0Ai4� t�.� 7a ERf3R154, ACT80456 t� V �by E3tGrM 15:#; <br /> ACT804.56 ' V Oj�4(3M 154; AGTti045ti CAk I tL91 B4 f#1; AGT119456 C,� '"I V 11)ERG#153; ACT80*6 <br /> CA L4 12)MM 1 M1; ACT89456C " -. - ;/ <br /> 33.Transporter Acknowledgment of Receipt of Matenals <br /> LU PrntedlTypad Name Signature Month Day Year <br /> rY <br /> O <br /> 4 <br /> z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed Typed Name Signature Month Day Year <br /> F •� <br /> 35.Discrepancy <br /> Zi <br /> v <br /> LUa <br /> v� <br /> M 36.Hazardous Waste R ement Method Codes(i.e.,eddies for hazardous waste treatment,disposal,and recycling systems) <br /> LU <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY COPY <br /> IF YOU RECEIVED THIS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e•MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE. <br />