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Phase - t of type.fF—de for use on elite 12-pitch) ter. Form 4proved-OMB No 2050-0038 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121 Ger—for 10 Number 22.Pays a 21 wrarw haddtq ww"ber <br /> (CmIlnualion ShW) CALOOOO 18659 of 2 00024599OWA5 <br /> 24 3'B44'li 4981_DINGS CORP. / DAWN 3ESS KMART # 3174 ! MCHC CLERK <br /> 3333 BEVERLY ROAD 2160 E. MARIPOSA RD. <br /> HOFFMAN ESTATES, IL 60179 STOCKTON, CA 95205 <br /> 25 Transporter --_-- Company Name U.S EPA ID Numbor <br /> 28. Transporter-- Company Na"'s Number <br /> 277. 27b U.S DOT Descrodon(incttding Proper Strppag Name,Hazard Class,ID weber. 28 Conlanxxs 29 Total :P).Und <br /> HN and Padceg Group(i(any)) 31.Waste Codes <br /> No Type Ouantlry WI Not. <br /> X 5. RQ UN3139 WASTE OXIDIZING LIQUID, N.O.S., 141D001 ' <br /> 5. 1 ME (HYbROGEN PEROXIDE SOD UM xZi � I <br /> HYPbCHLObITE), (D001),ERG#14b <br /> X 6RQ UN2929,WASTE TOXIC LIQUIDS, FLAMMABLE DOO1, D016 D <br /> i(�)ARG I I, -'T—� r-j <br /> 6. DICHLOROPHENOXYACETIC ACID), (DO37 D001), XXX XX XXX X XXXX: XXXX 'XXXX <br /> ERG#131 _ <br /> XXXX XXXXIXXXX <br /> sX 7Nn R. , I C, 1 791. D002u� I X <br /> X S. RQ UN3266,WASTE CORROSIVE LIQUID BASIC 123 D002 <br /> INORGbFlIC N.O.S. ,8,PSI I, (SOD I U HYRO�(TDEl, <br /> (DO02),ER6#154 X ) Z <br /> � t <br /> i <br /> t <br /> t <br /> i <br /> T.__._._ <br /> I <br /> _ 1 <br /> 3 _ 7w -*Wd0& @450310_LDR _ .W10 9450285_LDR <br /> -7& &r-6I <br /> 34) <br /> 33 <br /> l � cFxc6 <br /> 33 T t of of Mate"ats <br /> U9PmAnd/Typed Name Signature Month Day Year <br /> O <br /> R <br /> Z 34 Transporter AtArU*edqTwnl of Rempt of MaWats <br /> Pnnted(Typed Name "lure agith Day ear <br /> t— <br /> 35 D*aeparxy <br /> v <br /> 4 <br /> 36.Ha!%dous Waste anage rwA Me"Codes(i a krlieiardous waste t7atnenl.di o3lto4Wng systernsla <br /> H141 <br /> C7 <br /> uj <br /> O <br /> EPA Form 8700-22A(Rev 3-05) Previous edibom are obsolete DESIGNATED FACK.ITY TO DESTINATION STATE(IF REQUIRED) <br />