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I ' <br /> lose Print art e. Form designed for use on elite(12-pitch) ewriter. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 Generator IO Number 22.Page 23,Manifest Tracking Number <br /> (Continuation Sheet) CAL000412175 2 015886554JX <br /> 24.Generalor's Name <br /> COSMOPROF VEAIJTY f(M1 <br /> 25. Transporter Company Name �M. U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> U.S.EPA 10 Number <br /> 27a. 27b 0 S.DOT DesrripWn{including Proper Shipping Name.Hazard Class,ID Number, 26.Contamers 29.Total 30.Unit <br /> HM and Paokmg Group{if any]} 31,Waste Codes <br /> No. Type Quantity Wt.No1. <br /> ][ UN1479.VMTE O COW SOLID,N.O.S.(POTASSILIA 141 D001 <br /> P ORSULFATE.SOMA POWAJILFATE),5_1..PG 0 , � '� � •-- <br /> 32.Special Handling insmx4kris and Additio al Information <br /> 5) r k <br /> PRUARY M42OIRTER: TEMARRY IRIECYCUW INC. <br /> a 33.Trarrooder AWowledlgment of R eceipt of Materials <br /> F PrinledlTyped Name Signature Month Day Year <br /> cc <br /> to <br /> a- <br /> 34- <br /> 34.Tran ar Acknowledgment of Recei t of Materials <br /> PrintedlTyped Name Signature Month Day Year <br /> F <br /> 35.Discrepancy <br /> J_ <br /> C.1 <br /> d <br /> LL <br /> 17 <br /> 113 <br /> 36.Hazar ou Wasle Report Ma meat Method Codes(i.e..codes for hazardous waste treatment.disposal,and recycling systems) <br /> s' <br /> W <br /> Q <br /> EPA Form B700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />