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lease pirint or Form designed for use on elite 12 itch typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23,Manifest Tracking Number <br /> (Continuation Sheet) CALO00412M 3 01585555&5 <br /> 24.Generators Name <br /> SALLY BE iTY SIMPLIM 410339 <br /> 25-Transporter Company Name TRlrlsdlINC. <br /> U-S_EPA I Number <br /> 25-Transporter _. Company Name U.S-EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, 28.Conlainers 29 Total 30 Unit <br /> HM and Packing Group(if any)) 31.Waste Code:, <br /> No. Type Quantity Wt-Nol. <br /> x LN1479.WAM ODODMO BOLD,N.O.S.(POTASKA 141 DO01 <br /> PNRMA-FATE.ZOOM P1RS"ATO).5.1.PGS — <br /> i <br /> i <br /> a <br /> I <br /> 32.Special Harvchng Instructions a Additio a Informs'on <br /> sy R t l <br /> PRMWY STM TBIARW RECYCLPt1G INC. <br /> 33 Trans iter AplkjiovAadgmeiit of Receipt of Matenals <br /> F pnnted7yped Name Signature Month Day Year <br /> C3 <br /> a <br /> Z 34 TransWer Acknowledgment of Receipt of Materials <br /> Printedfryped Name Signature Month Day ear <br /> F <br /> 35 Discrepancy <br /> J_ <br /> a <br /> w <br /> 0 <br /> uu <br /> a 36-H rdous Waste Re Management Method Codes(i-e. codes far hazardous waste treatment,disposal.and recycling systems) <br /> z <br /> N <br /> [JJ <br /> O <br /> EPA Form 8700.22A(Rev.3.05) Previous editions are obsolete- DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />