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Please drat or e. Form designed lot use on elite 12• itch typewriter. Form roved.0616 No.20500039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Pace 23.Manitost Tracking Number <br /> (Contlnuatlon sheet) CAR 0 0 0 2 2 0 0 4 6 2/2 0118 3 0 3 2 0 F L E <br /> 24,Generator's Na"CALIFORNIA HEALTH CARE FACILITY(07557) <br /> Us EPA ID Number <br /> 25.Transporter 3 Company Name TRIMSA USA INC. CARO 0 016 3 8 2 4 <br /> A ID Number <br /> 26.Transporter Company Name <br /> 1 <br /> 278. 27b.U.S.DOT Descnptitm(inc?ud ng Proper Shipping Name,Hazard Gass.ID Number, 28.ContaAers 29 Total 30 Unil 31,Waste Codes <br /> HM and Packing Group(H any)) No_ Type Quantity WI Nol. <br /> Z <br /> O I <br /> H <br /> o Q' <br /> O <br /> w <br /> W <br /> c� <br /> Ft I <br /> I <br /> i <br /> l <br /> r <br /> 3 <br /> 32 Special Handtog Instructions and Additional Informaton <br /> a 33 Transporter 3 AckwNledgmenlo►Reati lofMatorias <br /> W PrintedRypedName S�gnalure r 't N.omh Day Year <br /> TOMAS CAMACHO 101 103 119 <br /> a <br /> 34 Trans r Adrad opntotRece,.io►Ida.enaa's <br /> PdnledlTyped Name Sgnatufe f7onth Day ear <br /> 35 Discrepancy <br /> U. <br /> 4 36 Hazardous Waste Report Management Melhod Codes It e.ccdes for hazardous waste treatment,disposal,and(egUiN systems) <br /> z ' <br /> w <br /> a <br /> EPA Form 8700.22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> i <br />