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Please print or type,(Fofm designed for use on elite(12-pitch)typewfilcr.) _ ?q 2 4.l 3 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generalor JD Numbe, WMApproved.OMB No.2050-0039 <br /> (Cantinas#tan Sheat) 22 Page;� 27•ManiiesJ Tracking Numbor ' <br /> Irl„1 I,J• t. to f 1 <br /> 24.Generators Name C1 )[]].I► � )I}�}'I' <br /> HIS LOTS 51foRES <br /> �? a 27 -2708 <br /> 25.Transilortef__ Cpmpany Name US,EPA ED Number <br /> 26.Transporter_- Company Name U.S.EPA IU!#umter <br /> 27a. 27b.i1.S.,D0T DeasriPJipn{induding Praper Sh pping Name,Hazard Class,ID Number, 28.Conlai me <br /> HM and Packing Group(if any)) 29.Total 30.Un.t <br /> ' <br /> 5 NON-RCRR HAZARDOUS WASTE LIMB (NATER BASED PRODUCTS) No. Type Quantity W[No!. 31_WasleCnrfes <br /> 331 <br /> c <br /> x <br /> a <br /> HP fbEfFHER <br /> w <br /> t3 <br /> u <br /> -Sfi- <br /> x <br /> I3 <br /> 14 <br /> 32.5pecsaEHandEinglnshuclionsandAddilionalhdonnalaon (51 BLNOI�AEfiLIq-D3 - NON-RESUI.ATED WASTE n <br /> 33.Transporter mentafRaxipt0#Malerials <br /> J'J 7Yedfry{aed Name <br /> a Signalure <br /> n� Monfh Day Year <br /> � 334.Transporter__q� e�r�nlafReceipt of Materials <br /> Pdnted ypad blame <br /> + Signage <br /> Month Day Year <br /> 3�.L)isaapancy <br /> ,.r <br /> U <br /> U< <br /> d <br /> ria <br /> 36-Hazardous asJe Repaq Management Method Codes(i.e-,cedes for hazardous waste JreaEmetll,d'rsp <br /> osai,and recyding sys€ems �} <br /> (7) (91 <br /> EPA Form 8700-22A <br /> (Rev,3.05) Previouseditfons areohaolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REOUiRED) <br />