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Please rint or t e. Form designed for use on elite 12• itch ewriter. Forth Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21,Generator ID Number 22.Page .� 23.Manifest Tracking Number <br /> (Continuation Sheet) - v. rl•�-:;_,3 i _;_ _ ;�r.% C'�t <br /> 24.Generators Name <br /> p Company <br /> U.S.EPA ID Numberr.10 152 34f <br /> 25.Transporter ler Com an Name <br /> U.S.EPA ID Number <br /> 26.Transporter Company Name _ _ , <br /> G L t a. G Sd fAA P N 0001 <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Conta hers 29.Total 30.Unit 31.Waste Codes <br /> HM and Paddng Group(if any)) No. Type Quantity W Woi. <br /> ( <br /> 3 t <br /> t , <br /> I <br /> t <br /> , <br /> • I <br /> I <br /> ! <br /> IX <br /> 0 ��..—. <br /> ( <br /> LLI <br /> 0 <br /> W t <br /> z t <br /> E <br /> e <br /> 1 <br /> ! <br /> ! <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter 2.Acknoviledgment of Receipt of Materials <br /> Print edlT me / Signature Month Day Year <br /> Ix <br /> 0 02- 1c>51/7CL <br /> z 34.T ter� _Ad m i d ent of Receipt d Materials <br /> Printed7Typed Name Signature Month Day Year <br /> 35 Dkmpancy <br /> J <br /> U <br /> Q <br /> LL <br /> Q <br /> W <br /> G 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Vestment,disposal,and recycling systems) <br /> Z <br /> S2 <br /> cis <br /> LU <br /> 0 <br /> EPA Forth 87OD•22A(Rev.3-05) Previous editions are obsolete. DES!Gi Ilii ED PAC ILITY TC DES T[Nxi`!ON STATE(!F P,EMIRED) <br />