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Annt or type <br /> - <br /> NtFORMHAZAROptlSWASTE MANIFEST 21C'emeralor10Numbe- Form Approved.OM8No.2050-0033 <br /> (Continuation Sheet) 22.Page 23.Manifest Tracking Number <br /> .Generatots Name <br /> i.Transporter` y Mame <br /> US.EPA ID Number <br /> Transperter Con�arry Name <br /> 11.5.EPA ID Number <br /> a. 2T6-U.S-DOT codon tem 3 Rupe`-'" a Name.Hazard 0M.ID Number 2a.Containers <br /> A aid Paclurg Grotrp Cd any)] 29.7mtal 30.Unit 31.Waste Godes <br /> No. Type DuanMy NA.NoI. <br /> `1a1Y�fiV--111,jT,Nlk�'Ri;t2R REIilA.R31`_Li <br /> � iz p <br /> f;ut: RCfiR tiAZRRDOdS WASTE SOL-10 <br /> •=M: ice F'i2UDlICTS JNFlFIfr00, �( <br /> 41 <br /> =.ALN# LOT UNivE€i 1. Nfr:fE.-- LPMIS', i,a f•'€7f"li <br /> Special Handling InsWcdmns and Additonal IrdomnaGon <br /> 7' !�l <br /> franspdrler,AcknwAed9ment of Receipt of Materials <br /> ledlfYPed Name Signa€ure Month Day Year <br /> "ransporter�AcAravrledgment of Receipt of Maleriats <br /> SgnaEure Month Day Year <br /> Pavy <br /> dour WastE Report Managemertl Merhod Codes(i.e.,codes for h=rdous waste treatment,disposal.and recycling systems) /` f <br /> 18700-22A(Rev.12.17)Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> i <br />