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Pease print or type. Form designed for use on elile 12-pitch) "ter.I FomiAppmvtd.OMB No.205MO39 <br /> UNIFORM'HAZARDOUS WASTE MANIFEST 21•Gen3ratorlDNuraber 22,Page 23.Manifest Tracking Number <br /> (Codnuatfon Sheet) Id, 4 gncro ] .12 <br /> 24.Gereratars Nana Di P46 D— I. *'r 0 -5 <br /> [� <br /> Sfly-�b <br /> U.S,EPA ID Number <br /> 25.TransporterCompany Name <br /> U,S_EPA ID Nurr4w <br /> 2$.Transporter Company Name <br /> 27a, 276.U.S.DDT Descriptirn(indud"urg Proper Shipping Name,X=rd Class,ID Number, 23,Cantalners 29.Total 30.Unit 31.Waste Cade$ <br /> HM and Packing Group(dany)) Na. Type QuantRy WWot <br /> 1 � <br /> Do <br /> tea , <br /> w _ <br /> LU <br /> `— 3 <br /> CDnj �2a <br /> 32.S 11-land8�g9nstau�andAdditia�al lnlgrmatton �6 j55 $$S P -�' 13rc 'G'�?/ <br /> 1�8f r,C,Cr�►�7�r ,2115132 �6 /� <br /> .1 J1,90SZ15 <br /> T�'Ccw`.2tB?-3$ 6-a*17J IX65 <br /> 33,T er menl of Rene at a{Materials <br /> PrinterINyped Name Sgnatwe Murith Day Year <br /> CC <br /> Q <br /> G.. <br /> Z 34.T AcknoW rent of RernJat of Materals <br /> Prinledl7yped Name urs ant, ay eer <br /> F <br /> 35.discrepancy <br /> U <br /> Q <br /> tL <br /> Q <br /> 36.Hazardous waste RepW Management Method Codes(I.e.,codes for ttiazar&us waste treatment,disposal,and mcy6ng system) <br /> z , <br /> CD <br /> W <br /> w <br /> v <br /> EPA Form 87CC-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />