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Please print or tvoe. (Form lesioned for use on elite r17-nitrhl tvn—rit—I <br />-- --• 1 `""" 1 ""w ""1.— 1-1" °" UU u,tiC. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />- <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />- <br />Generator ID Number <br />22.Page <br />-orm Approved. OMB No. 2050-0039 <br />23. Manifest Tracking Number <br />(Continuation Sheet) <br />121, <br />CA2890090002 <br />7 <br />005$70331 JJK <br />24. Generator's Name L srrrence Ltvermare Nnn31 '-3bor31Kt ;--rte :00 for NNSA _ <br />P.O. So'x 508 J L-756 <br />UN rmore CA. 94551 <br />25. Transporter Company Nama U S. EPA ID Mu.mbUlu <br />26 Transporter Company Name U.S. EPA IDNuMVIRONMENT—AL <br />Tr n!=P.,ARTMENT <br />27a 271b. U.S. DOT Description (inducting Proper Shipping lame, Hazard Class, ID Number, 22 Containers 29. Total 30. Unit <br />31. Waste Codes <br />HM and Packing Group (if any)) No Type Ouanlihy Wt Nal. <br />55. Cons..Inier comrrrodih7, ORPA-D (aerosols) [EF,G 171] <br />(DOPI0112-1) <br />741 <br />1 <br />DF <br />4 <br />P <br />56. Waste, Consumer corrrmdirl, ORM-D (aerosol) [ERG 17 1] <br />(C'OP0112-1) <br />331 <br />1 <br />DF <br />5 <br />P <br />IIs)75 <br />57. VkJaste, Consutrrer corrrmdity, ORM-D (aerosols) [ERG-- 17 11 <br />(DOP0112-1) <br />7.1 <br />1 <br />DE <br />25 <br />P <br />coal <br />0 <br />58 i24,Un saio,:► Rn me-«qsy CcoA}��nv-d �v1 <br />� <br />p <br />w <br />Z <br />Ct tz�) z poi �o--r t •- � � <br />) <br />b � <br />5 <br />w <br />0 <br />32 Special Handling Instructions and Additional Information <br />33. Transporter Ackno,vledgrrent of Receipt of Materials <br />LLI <br />Pnnted(Typed Name Signature Month Day Year <br />O <br />a <br />z <br />34. Transporter Acknowledgment of Receipt of rlatenals <br />Printedf I yped Name Signature Month Day Year <br />} <br />35 Discrepancy <br />F- <br />v <br />Q <br />w <br />0 <br />LU <br />Q <br />36. Hazardous Waste Report Management Method Codes (i.e., cedes for hazardous treatment, disposal, <br />z <br />C) <br />:vasle and recycling systems) <br />U] <br />ILLS <br />0 <br />7PA C,,.,., n7nn qmn ro.,.. I - <br />-- --• 1 `""" 1 ""w ""1.— 1-1" °" UU u,tiC. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />