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Please ont w Farm designed for uso on Mite I 12 ' ewtifer. Form Approveo.GMS No,2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST I1,Generator ID Number 22.Page 1 23.ManifestTr2d:tUng Number <br /> (Continuation Shestl A-�'r, C, ���, pF'-2 Dl l y$623 <br /> 24.GaneratarsName � u SD yf erb+� h2�.f b:< Sr g_c sL <br /> 3 5• �A-e-�`�G A-r��f1� <br /> 25 Transporter Caw;Nam U.S.EPA ID Number <br /> 28.Transporter Company Name <br /> U.S.EPA ID Number <br /> 27a, M.U.S.DOT DescrfPtbn tndu.&9 proper Snipping Name.Hazard Class,ID Number, 29.CoritaiPters 29,Total 30.Unit 31.waste Codes <br /> I'm and Paddng Group(N any}) No. Type 4uanity V Nol. <br /> ntanl '�rat2,4 r�z��.c w ��d. <br /> .831 <br /> LS. E A--14-br7 <br /> f <br /> 32 Spedal Handling Irut�udionv end Addlional I l� -- <br /> B�- 10je R s <br /> .JI-pAbJ5 , '►r-?l, - > 3 <br /> 60� VN <br /> 33,Tmnsportff AdMaWfedgrgert or Reopo of Malert b <br /> H Prtnle6Typed Name Signature MonUt Day Year <br /> lr <br /> Q <br /> rL <br /> z 34.7 nm1 of Ricelpt of Materials <br /> PnotgdlTyped Name rule Month Day Year <br /> r <br /> 35.Discrepancy <br /> J_ <br /> U <br /> d <br /> W <br /> O <br /> LU <br /> 36.Hazardous waste Report Marragemeet Method Codes¢.e.,codes for hnankxn wade treatment,disposal,and mcyding systems) <br /> z <br /> t7 <br /> r'n <br /> Uu <br /> D <br /> EPAFofm 87&22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />