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Please print or Form desi reed for use on OHM 12 tch titer. Form Applrov8d.OMB No,205o-Up38 <br /> UNIFORM HAZARDOUS WASTE 11A111FEST 21 Generawr ID Number 22.Page 23.Ma nifesi Tracking Numlgr <br /> [COndnuafion Sheet] ; I1 1^ <br /> 24.Generalofs Haase L� <br /> N 1Yso <br /> 25.TraworterpenYMame _ U.S.EPA 10 Number <br /> Vq a StWfIrpi 1r)(1R q� <br /> 26.T—apurter,Company Name US-EPAID Number <br /> 27& 270.U.S.POT Descri0on{indudng Proper Shippiy Name.Hazard Gess,Id Number, 2g,GDnts ars <br /> HM and Pacldng Group(eany}} 29.ToHr 36.Unit 31.Wsste Codes <br /> No. Type Ouanli[y WtNal, <br /> E <br /> r <br /> a <br /> r_ <br /> w <br /> fI ................. <br /> 32.Special Handling Imlructiorts end Additional Infnmration <br /> a. <br /> 33,Tnansporlar Aclkwwled menlol of MaWUs <br /> FW„ PrinM(TyW N Signature Month Day Year <br /> a I� !' r <br /> i 34,Tr A.know mem of Recei tof iAalerials f ¢ <br /> PridedlTypedName nawre Month OV-7m–r- <br /> 311 Ha rdms.Waste Report Mama"nt MOD"DAA(is.,codes For hazardous wasre Wa"Onl,disposal,and recycling v)ft sl <br /> [7 <br /> w <br /> w <br /> 0 <br /> EPA Form 870Q22A(Rev-3-05)Previousedi5ons areobsolele. DESIGNATED FACILITY TO DESTINATION STATE OF REQUIRE0) <br /> May 15,2019 pg. 10 <br />