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Please print cr lyptE.+,f fon 5jinod for use on elite(12-bitch)typewi nter'j _ Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST1121 Gfmrsad it 10 Num wr �g � 22.PW;n an <br /> 23.Mifest Tracking Number ,/'7/► <br /> (Continuation Sheet) t_ ;tX G f L�F <br /> 24 Generator`s Name <br /> 25. Transporter J.S.ERA C Number <br /> , W-zld-z- <br /> 26 Transporter..._ Cin,spany Name J.S.EPA!"Number <br /> 27a ?ry Lr t.S_DDI scn,�Aion m=e C.4 F ZiWN, _„ I?.i,a, Hazard Ch s,IG Nursbcr, 2 8,Costa nam 29 Total 30,U-it <br /> 31 Waste Codes <br /> HP,t and PKurs group;:#any'!; N.. Tyne Quartivy WLIV01. <br /> i <br /> CJ <br /> w <br /> Z _ <br /> tsi <br /> C9 <br /> 32 Special Handling hnstructions ant Additional Info:oration <br /> � 13 7:an ewer ....... .Az Icosvr-114me±tt of Rocel?t if Mile^t,ts <br /> ILU P€ t• orf I'll <br /> u S quit Ment! Clay Yeas <br /> a <br /> 34 arias>aner Atr�iaa+xtuti,a rid ct#tom' ar#9e eaals <br /> Z 9' " <br /> .:. <br /> Pr.ntera y ed Name, <br /> Snatur Mont#+. Bay year <br /> 35.i:ie:tepar!y <br /> t <br /> .:i <br /> Uj <br /> 40 c:s <br /> ca <br /> �I6.Hozar:ous':'Yash r�r,p,5t[Mar�egemen;t4e4ha;9 t:o�:es(i.e._cones`:cr irazarncus waste Eraatrnen,,Jis,�c�at,sr:�t resgr�lrtg systems; <br /> � tl <br /> us <br /> t� <br /> ERA Form 6700.22A"'Rev.3-G5) Previous editions are obsove. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />