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w - <br />Please <br />Eling or e. <br />IForm dost ned for use on <br />V <br />12 (ich <br />ewrller. <br />Form Approved. OMO No. 2050.0039 <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />21• Generator ID Number <br />22. Page <br />23. Mantled Tracidng Number <br />(Continuation Sheol) <br />1 C&OV14 I 5117f, <br />t <br />24.GeneralorlsName SuUrN G iuld Illndivid rWidniinri Stndctnn Waianl blur„f <br />2505 W Hrlrnuin► Ln <br />StncltMil, CAVI <br />25. Transporter Company Name U.S. EPA ID Number <br />26, Transporter. Company Name U.S. EPA ID Number <br />27a. <br />I1M <br />27b, U.S. DOT Desulpllon (Including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (If any) <br />28. Come era <br />29. Total <br />Ouanlity <br />30. Unit <br />WWoI. <br />31' Waste Codes <br />No. <br />Type <br />X <br />UNI 950, W.t'sle A lfosnfa, 111CIN011, 81101 not exrxracH11111 l <br />cdspatilloo 2.2' J44111 <br />I <br />QC <br />J 11 <br />X <br />UN1479, WA57C CWdIA1111 Knlid, 11.o.a-Wonfulns Silver NiVntn, <br />Polasaivim ttilmkv) <br />pt <br />r <br />P <br />C1f0i <br />15111111 <br />K <br />11Ni 6:17, lArtion Cfhyt r#dnlida, 2.1 , <br />Dr <br />P <br />131 <br />(Mfr1 <br />a <br />0 <br />a <br />w <br />z <br />LU <br />0 <br />32,S pecial Handling Instructions and Additional Information <br />S)nions C:1:1,4m F,)N77.131 ('17iow '/)n4F)?32 r1VA11 <br />v/ r” f KC' . I X f, <br />33. Trans orter Acknowled mentofRecei tofMaterials <br />Printedfryped Name Signature Month Day Year <br />O <br />a <br />z <br />34. Transporter . Acknowledment of Recei t of Materials <br />Prinledfryped Name Signature Month Day Year <br />35. Discrepancy v <br />U <br />LL <br />D <br />a36. <br />H�{dous Waste Report Management Method Codes (I,e„ codes for hazardous waste treatment, disposal and recycling systems) <br />z <br />014) <br />w J <br />EPA Form 8700.22A (Rev. 3.05) Previous editions are obsolete. <br />THANSPURTER'S COPY <br />