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Plaase nrintnr tune fFnrm deslanad fnr Oce nn elite N 2-oitchl tvoewriter.) Folin Approved. OMB No. 2050-0039 <br />EPAForrtYb QO A(Rev. 3.05).. P`wlous ed1dons are obsoleta. GENERATOR'S INITIAL COPY <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />.2t. GQne,;ata ID Number F._ rye Wpe <br />23. Mariifest Tr <br />I)tg "r J } <br />(Continuation Sheet) <br />24. Generator's Name <br />qtr• j .� +r � [ } •_� r'�' �J' l l_ � �• �` - �L j i <br />�•. <br />�•' .. ., <br />`vF{ <br />U.S. EPAID Number <br />25. Transporter Company Nam <br />� ",� <br />f. +t .•, ���.• ,�r.t•rrf•r.>1 ±. r" y+: <br />U.S. EPA ID Number <br />26. Transporter Compairy Name <br />27a. <br />27b. U.S. DOT Despipton Oncluding Proper Shipping Name Hazard Class, ID Number, <br />28. Containers„ <br />29,3ofal - <br />- <br />30: Unilb <br />`�Ifk1�oZ <br />_31aNast�Cod <br />=— -No.- - - <br />..Type... <br />HM <br />(�lUAr1 <br />✓, <br />i <br />OY <br />a' <br />LLI <br />Wxi <br />- a r i - `•. _i.i ,rte.J_ <br />•,..-._. wits <br />s .Y.,Y <br />.... <br />-. <br />r <br />� -Y> T -/3J' � + ��^_: a�l�-. <br />R.;- k 3t•' ... <br />'a.<Y• .... _�. <br />_ _ <br />- +"mss,,. <br />f:i-..y,- <br />,! •b•:!A - <br />.. <br />..._ ,- <br />r - r <br />`�'t�t`n ?:`<i :..'.r:,"Ct11:;1f^1E•i.;�;A^',g�'r•..v t t•C•i:.81"t•i^a7.��s.�, _ <br />r <br />Y <br />L <br />.i' <br />32. Special Handling Instructions and Additionalinformakri <br />33. Transporter Acknowledgment of Receipt of Materials <br />F <br />Pn'nt"Typed Name r SI¢Iallre Montt Day Year <br />LL— <br />CL <br />=34:rms r - :--::JAdwowladgment:ofRecel tofMateriale «. .�.s : -s. — a� _: , :. .-•t <br />Pdnted(fyped Name a Sllinetrre Month ~ Day Year <br />35. Discrepancy <br />v <br />pLL <br />1--- <br />36. Hazardous Waste Report Management Method Codes (.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />C9 <br />ca <br />tL <br />D <br />EPAForrtYb QO A(Rev. 3.05).. P`wlous ed1dons are obsoleta. GENERATOR'S INITIAL COPY <br />