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Pleesewim or Form desianed for use on elite i 12- Form AWoved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21. a 22 <br /> (CoMadwSwt 'M— ft Pel G 27 Manihst Trsd ing 284381WAS <br /> 24. , <br /> I U.S.EPA Ju Number <br /> 3333 BEVERLY ROAD n180 E. MARIPOSA RD. <br /> HOFFMAN ESTATES, IL 50179 STOCKTON, CA 95205 <br /> 25. Transporter Company Name <br /> Number <br /> 26. Transporter Company Norms <br /> 27a, 27b.U.S.DOT Desa"w(Frdudng Proper ShkOg Nam,Hazard lam.ID Number, 28 C nt*ws 29.Total 30.Unit 31,Waste Codes <br /> HM and P&*V Grow(it any)) No. Type Own* WLNd. <br /> 3,PGII, (PAINY), (D001),ERG#128 ' .— 1 DOO <br /> DG –915 <br /> (xbr-x-15 P1 <br /> UN1479 WASTE OXI IZ7Z SOLID N.0 ) 14 D001 <br /> ER1� I I, (TRICHLORO-S-TRIAZIN IONE), (D001), _ <br /> I OF a <br /> 5. 1 .b I (�IY� NRAR 11 ' ' ' ' 141 D001 <br /> HYPbCHLOhITE), (D001),ERG#146 Fol <br /> Fx 1 F P <br /> c c ' ' Vie <br /> o ORGANIC, N.O'S. ,6. 1( ), II, <br /> (PENTACHLOROPHENOL, 23,4- C ce P • - - <br /> W_ <br /> 1 `! U001),c� kG 1 <br /> ERG#154 ' ' '6 o <br /> r-xts 1 F 150 P <br /> INDR ICS N: ,8,PGI I }u GI IR�}`rTo-� ' T <br /> HYDRO C ACID), (D0023,ERG#154 J <br /> (D00c ,ERb,#154� ' U H �R }, l 3 <br /> I QIEX <br /> PAINT, DETERGENTS) <br /> Dnn <br /> 3e _ _ T'0 Q450c^ DR 12-.`W23—'s 5 01190' ( j VC fia r-ew i (U55 dj- <br /> _ J _ <br /> c�c3 Aj 3 <br /> PirG F4a x <br /> 33.Twww Adrowledgment of Reopipt of Matervis <br /> �u Pmto0yped Name Signature Mont Day Year <br /> cc <br /> S <br /> Z 34.Trans" of Peceipt of Materiels <br /> cl Prtntedlyped Name &gnahrra Mcflthay ear <br /> I-- <br /> 35 D—pancy <br /> J <br /> U <br /> Q <br /> im <br /> 36.Haa Wus Waste OWUhnagement ueftkGodes(i e.. waste v t,d system)B. H141 13. H141 <br /> 9 <br /> c lti, 11. H141 1c. H141 <br /> EPA Form 8700.22A(Rev.3-05) Prevrous editions are obsolete DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />