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Please print or type. Form designed for use on elite (12= Itch) typewriter, Fonn Approved. OMB No. 2050-0039 <br />EPA ForN A(Rev 3-05j. Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />UNIFORM! MANIFEST <br />8t_ Gqnet� 14(Wrr@beG4r+y t'r", =w.. <br />22. Page <br />23. Madfest cjd <br />` <br />(CHp2/kRDuadort Sheet) <br />_ <br />24. Generator's Name <br />W <br />' U.3> ID Number <br />25. Transporter �� Company Name I N., •, <br />rvY� <br />jt- f• ,r w✓,r'",ft , <br />_lr..�.r>l:/ , �� f.: �'!•:ly�yf7 <br />U.S. EPA ID Number <br />26. Transporter Company Name <br />27a. <br />27b. U.S. DOT Desafption Qncluding Proper Shipping Name Hazard Class, ID Number, „ <br />� 26. Containers <br />26i3blat - <br />30: Udb <br />,f <br />HM <br />,end Padd 8reri ' - . _:: ,mowa . ,-. • -. .: - <, <br />�1 t. <br />=31.�(ste <br />- - <br />-'_ , _ ';-,+ ;:• ::Era •.. .: - .,u:.; - <br />W <br />xl-tr. 46 <br />� zr�c",; <br />•:y' <br />m <br />���'.l� �•:24'+n. a.�•�•4 a�•':14 �1t.•b'q- f, 'a� .{ANt'°aT. �.%K S `9-.• <br />.Gf F. wNC <br />'l.:;f"=.:� <br />T�y <br />32. Special Handling Instructions and Additional Information <br />33. T Ado ent of Receipt of Materials <br />19 <br />PrfnWTyped Name Signature Morgh Day Year <br />.w <br />Q <br />Ca <br />ant of Receipt of Materials <br />Printed/Typed Name Swore Month Day Year <br />35. Discrepancy <br />36, Hazardous Waste Repat Management Method Codes (.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />O <br />EPA ForN A(Rev 3-05j. Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />