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Ci S:C 57 5 3: - @349 <br />Please print or type. Form desianed for use on eli GENERATOR 1 UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. Generator ID Number <br />(4751.1 //./ i 01 q <br />22. Page <br />ruin' twouveu. LAM NO. ZUOIJ-UUM <br />23. Manifest Tracking Number <br />iO / 2 (f 't 6F7() /1,16—. Generators Name <br />U.S. EPA ID Number Transporter Company Name /..../,_ rL,cp-t i <br />Transporter Company Name U.S. EPA ID Number <br />I_ <br />27a. 27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 28, Containers 29. Total 30. Unit <br />HM and Packing Group Clf anY))31. No. Type Quantity WUVol. Waste Codes <br />— 1 <br />' <br />. . <br />• <br />— <br />‘ ' <br />. . • <br />It <br />• <br />Special Handling Instructions and Additional Information <br />, <br />re UJ F— re o .. - z g <br />Transporter Acknowtedgrnent of Receipt of htsterials <br />Printed/Typed Name Signature Month Day Year <br />11 4 fr L (-)c) i 4- 1,12 I /1,1 1 1/ 11111W <br />Transporter Acknowledgment of Receipt of Materials <br />Printed/Typed Name Signature Month Day Year <br />I - I ' I • GNATED FACILITY I Discrepancy • <br />- , . • <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />. ' <br />Fs til <br />0 <br />• <br />I. I I I <br />EPA Form R700-22A (Rev. 3-051 Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />12922.1269