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Please print or tvoe. (Form designed fnr usA nn AINA I I2ne,M h -;re, i <br />trArDrm tim-uA(Kev. ml:)) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Shoot) <br />-- " —""' <br />21. Generator ID Number <br />CA2890090002 <br />22. Page <br />2 <br />Form Approved. OMB No. 2050-0039 <br />23. Manlfost TrackingNumber <br />0,537i 341 JJK <br />24. Generator's Name La?vrefv E Uv erroore '.3 O(`1zl a7,rior, '3rIE .x U Nr Fal S.y. <br />P.0 Box 208 / L-746 <br />Llifumore CA 94551 <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 />2Tb. U.S, DOT Description (inctud!ng Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Conta!ners <br />29. Total <br />Quantity <br />30. Unit <br />W Wol. <br />31. Waste Codes <br />No. <br />Type <br />5. Nlon•PCRA hazardous :vane, liquid (vfater tri;;ed wit4i sodium <br />suffire and diethanolamine) (00PGejL1-t) <br />2 <br />DF <br />131 <br />P <br />,�'�r <br />6R Dt FV-<bi-A0 <br />0 <br />w <br />z <br />LU <br />t7 <br />V <br />„, <br />�. <br />JAN <br />1,4 LUIV <br />11mrNNIAENTAL <br />HEAT <br />DEt ART <br />32. Special Handrmg Instructions and Additional Information <br />33. Transporter AdmoMed ment of Real I of Materials <br />j <br />Lx <br />0 <br />a <br />Printed/Typed Name Signature Month Day Year <br />N <br />34. Trans rter Aciuvwled mens of Recc I of Mater als <br />fated Typed Name S;gnalure Month Day Year <br />v <br />LL <br />O <br />Q36. <br />Z <br />t, <br />35. Discrepancy <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />ww <br />t] <br />trArDrm tim-uA(Kev. ml:)) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />