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Please print ar type. Folin Approved,OMB No.205 -0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number J� 22.Page 23.Manifest Tracldng Number <br /> (ConUnuailon Sheet) C�Q�q' 7 �� ��Q ��A 7 <br /> 24.Generator's Name <br /> um <br /> 25.Transporter Company Name U�A ID Nbe <br /> 26.Transporter Company Name S U.S.EPA 1(0 Number (j <br /> Va. 27b.U.S.OOT Description(including Proper Shipping Name,Hazard Gass,ID Number, 2B•t orMa oars 29.Total 30.Unit <br /> HM and Packing Group(if any)) 31.Waste Codes <br /> No. Type Quantity WLIYd. <br /> cc <br /> z <br /> LU <br /> r:o <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of hlateriaFs <br /> Lill Pnrted/Typed Nawnth��� FAonth D Year <br /> O <br /> ox <br /> 2 34.Tramporter AcknoWedgmentof Recei t of kla%riats `— <br /> PrintedlCyped Name Signa Month Day Year <br /> F <br /> 35.Discrepancy <br /> V <br /> 0 <br /> W <br /> Q 36.hazardous Waste Report Management Method Codes(i.e.,codes for hazardous+pasta treatment,disposal,and recycling systems) <br /> z <br /> C <br /> LU <br /> 0 <br />