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P print or type. Form designed for use on elite 12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.GeneratorIDNUMber 22.Page '" 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24.Generator's Name <br /> 25.Transporter Company Name U.S.EPA ID Number <br /> t 6 <br /> 26. Transporter Iq Com any Name U.S.EPA ID Number <br /> TV-J <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> O <br /> w <br /> z <br /> UA <br /> 0 <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> Pri ted/Typed Name Sig re Month Da Year <br /> ja l c <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> P.1, ypedNameigna a Month Day Year <br /> x <br /> '35.D'' <br /> Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> (RPY.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />