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01/26/2010 12:43 FAX fa004/019 <br />A l • • <br />J <br />Y `�JM Form AMOVed. OMB no. 2050 -Mg - <br />M. <br />1 <br />iaia rim ort term aeil ned ra tae on nae ie- ncn ..r,r•A aniteit nccumant No. <br />UNIFORM HAZARDOUS at. Generator'B S EPA ID No. <br />22.'P.age' ' <br />In(o dedon in the Shaded: , <br />by Fedeial <br />WASTE MANIFEST nn hh _ <br />l�`1LoGp�S`ii {C! I i Y f % <br />Y er9as Is not.required <br />oa law. <br />Continuation Sheet <br />L Stall nifeat D'acutfient.Numbef <br />23. Generator's Name <br />! <br />ilState Genera'tor's ID <br />24 h 5 Company Name 25. QS EPA 10yNymber <br />state Traneppner's ID ,. <br />C.TranepolteT'6'Phone� '-J I j'• ": ri'(, <br />26. TransporterName 27. US EPA ID Number <br />P .State hansponaYB ID' <br />0,' Transponer'a Phone ' <br />_Company <br />- S. US DOT Description (fnGuding Propar Shipping Name, HazaM Class and ID Number) <br />29.0tamers <br />0. <br />Type <br />Total <br />Ouantit <br />Unit <br />W Wol <br />WasR. Nd: <br />No <br />B. <br />b. <br />3 d. <br />e <br />f <br />qe <br />k <br />T <br />R <br />NOT AS LEGIBLE AS THIS <br />OVERLAY, IT IS LIKELY DUE <br />TO THE POOR QUALr Y OF THE <br />ORIGINAL DOCUN ENIS/IIvIAGE. <br />S. Additional Descriptions for Materials Lleted Above <br />Y. Noodling Cod" for wastes Listed Abore <br />32. Spa let Handling Instructions and Additional Inrormalicn , <br />3.Transporter Acknowledgment of Receipt of Materiels Dote. <br />R <br />A P�rinlad(Typod Nat7e naS� <br />N 1 •.-. ,i <br />e t03 0... ' �•._a Y' <br />0 34,Transponar�Acknowledgment or RBCelpt of Matedale <br />Montlr Day Year <br />R Signature <br />PrintedlTyped Name <br />E <br />P <br />5. Discrepancy lndlcatiQl! Space ' <br />.:I,:,10FA Fw e7paaaA (r .a-ealPrwu edltl n 1 bbadete FILE COPY OR STATE COPY <br />