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Please print or tvve. (Form designed for use on elks H2-nitrhl tvnawr;tar 1 <br />trAromr aruu-LLA(Kev. s -UO) rrewous etnuons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />- <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(ConUnuaUon Shoot) <br />- <br />21. Generator ID Number <br />CA2890090002 <br />22. Page <br />2 <br />rununppruveu. vmn No. zuDU-Utla9 <br />23. Manifest Trackln Number <br />F45370341 JJK <br />24. Generators Name Lawra-ace uernlore P.a onal Dijraiory 5rle U or jij f,j ::j.y. <br />P.O Box eO8 ! L-746 <br />LNArMore CA 91551 <br />25. Transporter Company Name U.S. EPA ID Number <br />26. Transporter Company Name U.S. EPA ID Number <br />27a. <br />HM <br />27b. U.S. DOT Description (irc ding Proper Shipping Name, Hazard Class, ID Number, <br />and Paddng Group (d any)) <br />28. Contalners <br />29. Total <br />Quantity <br />30. Unit <br />WINoI. <br />31. Waste Codes <br />No. <br />Type <br />5. Plan-RCRA hazardous vvaste, liquid (vrater mixed with sodlurn <br />sulfrte and diedlanolan�ne) (DGPCOIC-1) <br />2 <br />DF <br />331 <br />P <br />i41 <br />Q1Un �I1, (Lr5'��'� Vxid\z tR ,tip tl,0. <br />� bromo- cti�;t _ d'�,�>✓tl�Yl d�yd4�n lr;,, ' � r 1,?�"' <br />k ERb1-10 <br />�j <br />Qin <br />cc <br />Z <br />W <br />AN 14 <br />016 <br />H E; <br />�, - <br />��`t` <br />.NTA <br />rev <br />32. Special Handling Instructions and Additional Information <br />33. Transporter AdwMed ment of Reoel 1 of Materials <br />t�! <br />O <br />a <br />Pdnte0yped Name Signature Month Day Year <br />y <br />34. Transporter 1 of Receipt of Materials <br />Printed/Typed Name Signature Month Day Year <br />u <br />LL <br />O <br />Q36. <br />x <br />0 <br />35. Discrepancy <br />Hazardous Waste Report Management Metlwd Codes (i.e.. codes for hazardous waste treatment, disposal, and recyding systems) <br />y <br />W <br />O <br />trAromr aruu-LLA(Kev. s -UO) rrewous etnuons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />