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05/20/2010 THU 14: 03 FAX 612 696 5163 0007/010 <br /> Please pint or lypo. Form desi ned for use on elite 12-nisch)( emiter. Form Ap royW.OUB No.2050-0033 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21,Gewalor ID Number 22,Page 3 23.Manifest TraAing Number <br /> (ConOnuallon Sheet) rni �Z77 <br /> 24.Generators Nama <br /> TARGET—T0738 / Rl VERSE LOGISTICS SPECIALIST l TARGET—T0738 / EXEC. T EAfd LEAD%REV_ LOG. <br /> Snh NAGLEE RLQ. 2800 NAGLEE RD. <br /> ra U.S.EPA 115 umbor <br /> 25.T.xspoder Company Name <br /> U.S EYAID Number <br /> 20.Transporter—__ Company Name <br /> 27a, 27b.U.S.COT Description(nrludmg Proper ShIDOrg Name,hazard Cass,ID Number, 28.Containers 29.Total 30.Uri( 31,Wa=fe Codes <br /> HM and PacldN Group(it any)) Nc. Type Ouenllty YVINoI. <br /> X 15. , ' <br /> 1 f�al� �'�� �.�r.-ref=�'k 4r A� ird {44"'T r F. -� i T <br /> r <br /> I-C-NDN RCRA HPZARDOIJS b)ASTE LIQUID (LATER <br /> pAiNT" 1 10P <br /> w <br /> W <br /> fI <br /> I � <br /> -- i <br /> i <br /> I <br /> 32.*Ml Handling Insln)cltons mdA46tjowl tnlornation <br /> 1£.W,1 x,512027 <br /> j X 30 <br /> 33,Tran AckroWedgment of Recti of Malcria s <br /> N f3hraed/Typcd Na" g Manlh Day Year <br /> g <br /> cO 3a.Tran Acknowi mens of Reoel of Matenata <br /> P Mad7Typed Name Signature <br /> trionui uay ear <br /> 35.Disrseparcy <br /> V <br /> ME HezardouaWasle Report Management Method CWK(i.e codes for hazardous want Ircalment.dli poed,and reading syslems) <br /> 1S. —W4-4i— 16. H141 <br /> r„ <br /> 0 <br /> EPA Form 87M2M(Ray,3.-05) Previous wkons are omolele. DESIGNATED FACILITY TO DESTINATION STATE OF REQUIRED) <br /> I <br />