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Please print or type.(Farm designed for use on ekle(f2-pitch]trrr <br /> ype :ler.j F Approved.Od'3 No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE hfANIFE,T 7.1 Generator Ip flambe 22 Pagc .3 23.Manifest Tracking Number <br /> (Continvalkori Sheet) E(�1_(3[1CJ3 .1[36 of 2 L1C)0_I.f33Ci'a71iAT <br /> 2.4.Generalo's Name <br /> 916 LOTS STORES <br /> 300 PHILLIP RD ATTN: DENA FERARU COLUMBUS OH 43228 (614)270-4514 <br /> 25- Transpurter—__, Comparsywame <br /> U.S.EPA 1D Nt ether <br /> 26.Trdnsimer._.._ Coff*"-Name tf 5 -Rt!D Yumhe <br /> 27a. 27b.U.S.1)OT(3esetiptiori fmciWng PoperShOpN Name.Hazard Olass.tD Ntarta 28 ColaMers 29.Trial 30 Until <br /> HM and Packing Group(if any)} No. Typa Ousntdy wtpli . 3t.waste Codes <br /> 5 NONCRR HAZARDOUIS BASTE SOLID IVRRIOUS CONSMER SOLID 352 <br /> PROAUTS) P <br /> X. <br /> a <br /> x Deifi- <br /> , r <br /> z <br /> X <br /> HIVAHOUS V0 <br /> 12 11141791 WASTE HYPOCHLORITE SOI-UTIONS 8 P51I 122 D092 <br /> I] <br /> 14 <br /> 32,SpacalF'an9figg1n5lnrdmrsandAddliorallnlamahen I W hNONRES50L-03 - NON RE&U ATIF9 SOLIH-i" <br /> 02! UnGTILEACH-04 ERG 154) BLEACH <br /> 33.'ranspoder Acknowledgment of Receipt cf Marenals <br /> LL�J PdriledlTyped Name S�Jnalom. Marlh Day Year <br /> 0 <br /> CL <br /> z 34.Transpo ter _AdmWedgmenl of Receipt c1 Maxmals <br /> Prinle(lTyped Name Sigttaiure 61arr:4 Day Year <br /> t-- <br /> 35.Uiscmpdncy <br /> 1 <br /> U <br /> d <br /> O <br /> Q3 .Haxardaus Wasle RwW Maragerxrl M&Dd Codes' s f It zardi waste Ireaimeni,eisposal•and ieayrjUig s stems) <br /> w <br /> 0 f101 E111 ii?I l (� <br /> EPA Form 8700.22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION TATE(IF REQUIRED) <br />