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FORM #FS-UHWM <br />UNIFORM HAZARDOUS <br />21. Generator's US EPA ID No. Manifest Document No. <br />in the <br />WASTE MANIFEST <br />(Continuation Sheet) <br />C A s 1 L 1 0 0 8 5 7 a29 1 2not <br />=Pagelnformation shaded <br />required by Federal <br />23. ■ r�"'.2:tPi'k <br />Document Number <br />18if3 Yt t1]t�t�Y'a6 <br />tr<ir,t, i w �92Gi a ni Iixiii ii:3Fl�:ui <br />(:204) 468- 3066 112a9) <br />M. State Generator's ID <br />4F's -3')6(1 <br />24. Transporter Company Name 25. US EPA ID Number <br />N. State Transporter's ID <br />26. Transporter Company Name 27. US EPA ID Number <br />O. Transportees Phone <br />P. State Transporter's ID <br />Q. Transporter's Phone <br />28. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />29. Containers <br />30. <br />Total <br />31. <br />Unit <br />R. <br />Waste No. <br />"^" <br />a. <br />No. Type <br />Quantity <br />WWoI <br />11w, -"M*T#tuts, i5 n"roua- wh4m veec .4P}!.. 't�t#@f► y <br />i• <br />P <br />Xtill <br />b. <br />=•.i � �� r f <br />.D'F <br />� <br />11rf7t <br />C. <br />G <br />d, <br />N <br />All <br />R <br />A <br />e. <br />T <br />R <br />f. <br />9 <br />�— <br />al jrr�ons for Matetr4j 1,,jW �ttr� �. , : f �, � f ,.7 ,. <br />T. Handling Codes for Wastes Listed Above <br />I <br />32. Sppecial Han dlin Instructions and Additional Information <br />lr"t® is axwVt pot as Cara 261.4(6) (1) amiusion. ftar pr"r era wtwn han4l.t,ng hazardous <br />a;atet#.a] a . 81t6 t b2d4 8. 't'reay Al d, "trac"CA 46376.1 Ju} it 1493-06200 j atm+ guides W4- , **- F i4# I, <br />T <br />33. Transporter Acknowledgement of Receipt of Materials <br />Date <br />A <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />N <br />s <br />P <br />R <br />34. Transporter Acknowledgement of Receipt of Materials <br />Date <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />A <br />35. Discrepancy Indication Space <br />C <br />L <br />1 <br />T <br />Y <br />