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s S, <br /> i. please' rinl or t e. Form designed for use on elite 12- itch t ewriter. Farm Approved.OMB No.2050.0039 <br /> ,,�I&bRM HA7AROOUS WASTE MANIFEST 121.GoneratoilD Number C� }} 22Pae 23.ManHestTracking Numpher <br /> (Continuation Shoot) C�R 0602.5?,5)-5 I�P,3100 e5 /7�3Z -E <br /> � 24,GenarototsName _ <br /> /17 <br /> U.S.EpAID Npm r � � <br /> 25.Transporter CempanyNamo <br /> 7 / U.S.EPA ID Number <br /> 26,Transporter COmpany Name <br /> 270, 27b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 26.Containers 29,Total 36,Unit 31.Wade Codes <br /> HM and Packing Group(if any)) No. Type Quanbly MNol. <br /> x <br /> 0 <br /> z <br /> APP <br /> , r <br /> ENV ROHM NT <br /> FPA.; Tei <br /> 32.Spe ml Handlinginstructions and Addibonalinformabon <br /> 7 7 <br /> 33.Trons dor _-Acknwhed mentofRecet tofMaterials <br /> Pdntedll'ypadNama�W� Signature Month Day� Iat� <br /> -- <br /> 0. � <br /> 34.Trans oder Aeknowied mentofRecer tofMaterials <br /> Pdntedriypod Name S gnature Month Day Year <br /> r <br /> 35.Discrepancy <br /> W <br /> 0 <br /> 36.Hazardous Waste Report Management Method Codes(t,e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> r i � <br /> rePAt omi,8700.22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />