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Please print or type. Form Approved,ONE No.20500039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator IN Number 22.Page 23.Menilesttracking Nomber <br /> (Continuation Sheet) f A 1) 9 R 3 1;is 0 a 4 I F <br /> 24.Generalofs Name <br /> r ieo±f too,'rt+6.,,h: 6ineRY.ur <br /> 25,Tookinder Company Name U.S.EPA 0 Number <br /> 2a,Trampmler Company Name US,EPA ID Number <br /> 2Ia2Ib.US OOT Description(Induding Proper Shipping Name,Nezard Duc ID Number 28.Containers 29.Total 30Unit <br /> HM and Packing Group(9 any)) Noyp <br /> . Te Quantity intake 31.Waste Cotles <br /> ft.NON 11i HAYAROOI15 WArq IF S,ifaF)i rllI; ;t1FFNI �ry2 <br /> b. <br /> CYIN fAR1lNAFFD WITH OILI 002 r;F 00014 P __... _._... ____... <br /> z <br /> 0 <br /> i <br /> w <br /> u <br /> 53W.04M Isommusi additional lMormmlon <br /> K Funtinns Name rwxletl mental Receiplof Ma@rials <br /> h Printetl?ypetl Name 91gnaWm Monty Day Year <br /> O <br /> 6 <br /> i <br /> N.Thandemat Acknowletlgmanlol Receiplol Malenals <br /> PhnletlRypetl Name Signature Month Day Year <br /> I- <br /> 35.Dismepanry <br /> U <br /> LL <br /> do <br /> 6 3fiHazeMous Was@Report Mana9emenlMeNotl Codes(i.e..wtles for hazardous waste lreaMenl,disposed.and reryding systema) <br /> z F..F1141. <br /> do <br /> w <br /> v <br /> Fri�IDQ 22A 4Re3.r12L117)r Previagks editions arre obTsrlete.f rr�ll...e.,rek.„�...,�r„fk,e u„rr,...r����. �.rri.e.= .. GENERATOR'S INITIAL COPY <br />