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FORM HAZARDOUS WASTE MANIFEST 21.Ganereto ID dumber F�MProved.OMB No.2050-0039 <br /> 22,Page 23.iluiNxtTreckEng Number <br /> (Condduadnn sheet) 5 6 6 6 7 <br /> 24.C walarb Name 2 <br /> 25.Transpodar Company Name U.S.EPA ID Number <br /> 28,Transporter Company Name U.3,EPA ID Number <br /> 279, 27b.U.S.DOT Descdptlon(Induding Proper shippkg Name,Hal Cissa ID Number, 23,Containers <br /> HM and Packing Group{deny)) 2B.Totd 30,Unit 31.Waste Codas <br /> _ <br /> No. Type Quantlty WtJVd. <br /> IL E0 n. stn <br /> l CF ! <br /> & WAI UCORRr�,nr$ <br /> 002MDOM <br /> 1 CF 66 i► <br /> 7.ID+II70.WAM HYDIOCRMV Apple,8,M 79 <br /> x <br /> DF is r ? <br /> 0 <br /> w <br /> z <br /> w <br /> c� <br /> 32.Special Handing Instrudions and Additional fmfomatlon <br /> as7 W-7156A Au>RMs�> a;7tsoalw: �H �s�W:7tsosr A: � 7)FIQ <br /> w 33.Trans r komel of Rem 3 of Metal <br /> UJ Pdnted7Typed Name <br /> S3gnaiur9 PRE, Day Year <br /> 34.Transportsr msntof Reewof Maledats <br /> L5 Primiadltyped Name <br /> f... Signature Month Day year <br /> 35.Dlsrlepency <br /> V <br /> UU.. <br /> G <br /> W <br /> F- 30.H DU le Repod Management M a(f.e cuf)es for harardoua waste tiesd and rscyo ft systems) <br /> N <br /> O <br /> EPA Farm 8700 22A(Rev,12.17) Previous edltinrrs ars obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />