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I(illyf�I NilIiiIIINI I i 111 if ilf <br /> X80598' 8 32668$5-001 <br /> 001947264PSC <br /> Please 'nrdYt e:'forrtt`desi ned foruse orj elite <br /> 2-pitch)typewriter.) F rm Approved.OMB No.2050-0039 <br /> IjNIFORM HAZARDOUS WASTE use <br /> :Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) L00039ib69- _. 2 Of 2 <br /> 001947264 PSC <br /> 24.Generators Name <br /> BIG LOTS STORES <br /> 300 PHILLIP RD,ATTN:DENA FERARU <br /> COLUMBUS,OH,43228{614)278-4614 -- <br /> 25:Transporter Company Name <br /> U.S.EP ID Number <br /> ` 26.Transporter ' - Company Name <br /> A I umber <br /> 27a :27b.U.S.DOT Description(including.Proper Shipping Name,Hazard Class,ID Number, 28.Cbntainers 29.Total 30:Unit <br /> HM and Packing Group(d any)) 31.Waste Codes, <br /> No. Type Quantity wt./Vol. <br /> 5.NA3077 HAZARDOUS WASTE,SOLID,N.O.S.(MERCURY)9 PGM # <br /> 181 D009. 1 - <br /> X DF 2 ? <br /> LU <br /> W > <br /> 1 <br /> . e <br /> 32.Special Handlinr�InstnrttionsarkAdditional Information . <br /> (5)BLCRSHBULB-03-ERG(171)BLCRSHBULB 03-CRUSHED,BULBS <br /> 33.T er Acknowled meat of Receipt of Materials <br /> tW— Printed/Typed Name Signature Month Day Year <br /> © <br /> 34 Trans der Acknow! ment of Receipt of Materials <br /> rite yped Name Signature Mbnth Day Year <br /> ) <br /> _. r 35:DisaepancY <br /> C1 , <br /> LU <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> (6)H141 <br /> W - ' <br /> EPA F66 8IM22A(Rev.3-05) Pievious editions are obsolete. ' J <br />