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07-02-'11 08:03 FROM-KING ISLAND RESORT 1-209-951-9181 T-470 P0003/0003 F-716 <br /> to <br /> Please print or type.(Form designed for use on elite(12-pi(ch)typewrites) <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number Form Approved.OMB No.2050-0039 <br /> (Continuation SLe 1 22,Page 23.Manifest Tracking Number <br /> t s it p 7y, <br /> 24.Generators Name it t1 " <br /> 25.Transport" Company Name =U.S Numher <br /> jj <br /> 26. Transpoder_rte— Company NameU.S.EPA ID Number " <br /> .: npr lti t t it e..., Ij <br /> 27a. 27b.U.S.DOT 0039000n(including Proper Shipping Name,Hazard Class,ID Number, 26.Containers , <br /> HM and Packing Group(if any)) 29.Total 30,Unit 31.Waste Codon <br /> No. Type Quantity WINoI, <br /> K <br /> O <br /> r— <br /> u, <br /> Z <br /> w <br /> I <br /> __...__ <br /> 32.Special Handling lns"ris andAdddmnal lnformatton i <br /> K 33.Trampoder_____.,Acknowled menlof RemWto(Malenals <br /> W Prinledfryped Name Sgnalure <br /> OMonth Day Year <br /> a <br /> 2 34.Trans er_—._Acknowl ment of Receipt of Materials <br /> PrinledrTyped Name Signature <br /> H Month Day Year <br /> 35.Discrepancy <br /> J <br /> U <br /> uQ. <br /> O <br /> W <br /> Q 36.Hazardous Waste Repod Management Method Codes(i.e.,cocoa for hazardous waste postwar,disposal,and mcycling systems)) <br /> Z <br /> C9 <br /> rn I <br /> w <br /> EPA Form 8700-22A(Rev.3-05) Pre.virnmadltinncamnhsnlpla <br />