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Form Aooroved. OMB No. 2050-0039 <br />:leabe <br />V111n un e. <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. Generator ID Number _ _ <br />CLl[. (�i�. /7L`/il/v// <br />22. Page <br />Z <br />aclSin9 Numb_e1,., <br />27d(�. Manifest GiY0I J/• �� <br />24 eq�jtor'ame �y S j Aa f LS <br />Vb}�Ds <br />U.S. EPA ID Number <br />25. Transporter Company Name <br />U.S. EPA ID Number <br />26. Transporter _ Company Name <br />273. <br />HM <br />27b. U.S. DOT Description (Including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Containers <br />29. Total <br />Quantity <br />30. Unit <br />WWoi. <br />31. Waste Codes <br />No. <br />Type <br />N.D - 4.ruR..c� az4sC• J E^^P� Sal�i7 <br />,3$ <br />,Jo (LL2A 7{.4ZhiZ�O+S tJASre �oLl p <br />(PR,ng-ree Caa-rye tdGE� <br />I <br />Dr <br />S <br />P <br />tbP <br />/� <br />01JO50t WA5TG k6a"OLSr 2.1 <br />Ee cl.- NO'j C><GLd�•�.� I L (S j,ac A—f <br />Doer( <br />you <br />331 <br />s <br />0 <br />w <br />z <br />w <br />32. qpecial Handling Instructions and Additional Information <br />s Ze°C2G (1><30 °/r) R A e- - 00(o <br />G eHs-261`1 j (\x 00%7-)t-Ae-00'7 <br />7 L66 r -6Z A 01 2Ae-ooS' <br />w <br />K <br />O <br />33. Tram tier Acknowledgment of Receipt of Materials <br />Printed/Typed Name Signature Momh Day Year <br />a <br />i <br />34. Trans er Acknowted ment of Receipt of Materials <br />Printedrryped Name gmdure Month Day Year <br />J <br />U <br />LL <br />35. Discrepancy <br />Q36, <br />z <br />O <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />y <br />w <br />0 <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIREU) <br />