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Please grintor type. Form designed for use on elite 92- itch t ewriter. Form Approved.OMB No.2050.0039 <br /> r UNIFORM HAZARDOUS WASTE MANIFEST 121.GeneralorlD Number 22.Page 3 23.Manifest 7rackingNumber <br /> (Continuation Sheet) CAR 0Q+259515 of 008597532FLE <br /> 24.Goneraloes Name <br /> CVS (SIB) #17+12 <br /> UP.EPAIDNumber, <br /> rx...ec�Or�t�aa <br /> 26.7ransporter Company Name <br /> yI- U.S..�EP/A�IDNuu�mber28.Transporter omJ�F N?gte )t�Y&fI J �{ / ljJ �F6106 �^� �' /V D <br /> t `` �"1'fV( GJiV <br /> t 210, 21b.U.S.DOT Descrfptian(Indudmg&W Shipping Name,Hazard Class,10 Number, 28.Containers 29.Totai 30,UNI 31.Waste Codes <br /> I HM erdPackMgGnaup(ifany)) No Type Quantity WINoI. <br /> f <br /> I <br /> O <br /> u! <br /> S <br /> W <br /> C9 <br /> , <br /> n <br /> 1 <br /> 32,Special Handling Instructions and Additional Information <br /> � 33.Tpns ar Acknowied mantotRece lafMatadais <br /> I—II Panted qd Nemo Signs re Month Day Year <br /> o ♦�' , <br /> l <br /> n. <br /> z 34.Trans orter_,.,_—Acknowledgment of Rl IofMatedais <br /> PnnledliypodNam a ,r ` a r gnalu Month Day Year <br /> 3S.Dlsaropancy <br /> Haz2Vus Waste Report Management Melhod Codes(I o.,codes for hazardous waste treatirml,disposal,and recycling systems) <br /> in <br /> .EBA1Forrn�70o•22A(Rev 3.05) Previous editions are obsaiete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED?; <br /> 3 rr w r <br />