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v Pleaseprint Or � gnedtdt UseOn alit 1ch ) Form Approved.OMB No.2050-0039, <br /> type. •(Form deal )typewriter. <br /> UNIFORM HAZARDOUS 121.GeneratorSUSEPAIDNo. Manifest Document Na 22.Page Information in the shad`s$""'!''-""' <br /> WASTE MANIFEST I areas is not required by Federal <br /> (Cd'htinuation Sheet) 2 law. <br /> 23.Generators Name '-`` ''Mr'4' I k"tN4 ` " L.SthteManifestDocumentNumber <br /> M.StateGenerators ID <br /> IOU', Di[F!fi '1'JAL MMICE. <br /> 24.Transport ` % -rp YI Narna"-' s�. = `'^` 25.US EPA ID Number N.State Transporters ID <br /> O.Transporters Phone <br /> 28:'Transpdrter Company Name - - -- 27. US EPA ID Number P.State TransporterslDb f <br /> O.Transporters Phone <br /> 29.Containers 30. 31 -„R <br /> 28.US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Total Unit Waste No. <br /> No. Type Quantic WWol <br /> a. <br /> Z ON RGBR 4L4 AA JSS XLM 345UP iRVA 9.$V AND OfMIa§ ; �.. JP", <br /> b• 'i4Vol 0A IMO.4�4on ll, wfai))(f;�l�tAI�iq:Yi cris ii(¢'Y!6(1 E.+'r <br /> ,uf <br /> C. <br /> Nsiii-A+;9A N�.".,ARltr.>ft KM rW-Ej,t'h'3?iN4 :Itrbt"Mj <br /> E d, NSA Pfrk£ 110M*103 NAMR? IC118311!!1 ItTr`IPt"""•5130 fq: <br /> R <br /> E <br /> R / <br /> A B. <br /> T VA-M 10t1,111 trtU".V!J%n,'P'; ih1 <br /> R <br /> f. <br /> 9 <br /> h. <br /> i. <br /> S.Additional Descriptions forMaterialsListed Above T.Handling Codes for Wastes Listed Above <br /> "+4 .mil"•4tK, - mvf"t 304 Pili MrA!.. Vt 111 1 , li7 f. 15"T &4 mrrT t(? Y`A;pn'C r3 t 1.t .,'g 31 a.� <br /> S?alt VAUMI Akl. 3i . Ay3t :>p t 33A,5'P:�ti? r.i$Z4A YUjlr?: <br /> ref Ws�� R`u�,c° #tS1 at•r'•4 �s 10Y.t?10 glfleaM'°m{ ; ti�1 1P 1 tint 5 , <br /> Special Hand`fd4 Instructions and Additional Information <br /> t <br /> 1111,1 <br /> T 33. Transporter _ Acknowledgement of Receipt of Materials Date <br /> A ,Printed/Typed Name Signature Month Day Year <br /> N <br /> S <br /> 0 34. Transporter_ Acknowledgement of Receipt of Materials Date <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> A 35. Discrepancy Indication Space <br /> L <br /> L <br /> Y <br /> r <br /> Style CF 18 LAULAASTIM®(1100)621-5108 www.labelmazler.cam EPA Form 9700-22A(Re¢9-ea)Previous edilions are obsolete. <br /> m ., " .... FILE COPY OR STATE COPY <br />