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,? P!ea�c•print or type. (Form designed for use on elititch)typewriter.) Form Approved.OMB No.2050.0039.Expires 9-30-92 <br /> UNIFORM HAZARDOUS 21.Gen )r's US EPA ID No. Manifest Document No. 22.Page Information in the shaded <br /> WASTE MANIFEST areas is not required by Federal <br /> (Continuation Sheet) r Q G 1(")12 A : of 2 law. <br /> 23.Generator's Name L:State Manifest Document Number <br /> R-0, Lab Rubber Corm.1viv <br /> 8F'1130 ' t Limy sxl6l' <br /> Z�C�'r ` 5�?k M.,State Generator's ID <br /> 24.Transporter C•) Company Name 25.US EPA ID Number N.State TranSporter's ID <br /> _ IQ <br /> Transporter's Phone <br /> 26.Transporters- Company Name 27.US EPA ID Number State Transporter's ID <br /> Transporter's Phone <br /> 29.Containers 30. 31. R. <br /> 28.US DOT Deseription(Including Proper Shipping Name,Hazard Class,and ID Number) Total Unit Waste No. <br /> HM No. Type Quantity Wt/Vol <br /> b. <br /> Nex-r-R PUN liazatndou3 Ltiaste LiquidC 352 <br /> -(Va,ste and mixed oil) <br /> C. on-.11r-RA i`aae`�rdous t' X48 SQ1 iC5 Cdr 4 352 ., <br /> (Irer3 G LPA, 4 ww <br /> N (Ethylene Glycol & a�ater) r t�� f .F 0 r < r�>A� i . <br /> E <br /> R <br /> A e fit..:;:}?l }iaza- r(f42., "iast ° Solij 52 <br /> T F }�,q{t NOW <br /> O L'C.'ltlrl.LZx�71c'ti. L '.. A9r ' <br /> ft,�,jµ7F .::. <br /> R <br /> f. <br /> W P- <br /> 9• <br /> h. <br /> i. <br /> S.Addiional Descriptions for Materials Listed Above . T.Handling Codes for Wastes Listed Above <br /> 2Ca3 -%99-14 Sol.11d Resin 7,14 <br /> 28b) 65-10 t to & Mixod sail .10,11,20 <br /> 28C) 17770-10 Gream <br /> 2£;dj 5869-10 Ethylene Glycol & mat:,or 19 <br /> 3 <br /> 23e) 5699-10 Polyurethane Salic: foam <br /> ':a <br /> T 33. Transporter J— Acknowledgement of Receipt of Materials Date <br /> NPrinted Typed Name Signature`, Month Day Year <br /> o 34. Transporter Acknowledgement of Receipt of Materials Date <br /> T Printed/Typed Name SignatureMonth Day Year <br /> A 35. Discrepancy Indication Space <br /> C <br /> I <br /> L <br /> T <br /> Y <br /> Style F16 REV-6 LABELMASTER,An AMERICAN LABELMARK CO.,CHICAGO,IL 60646 800-621-5808 EPA Form 8700-22A (Rev.9-88)Previous editions are obsolete. <br /> ®U°" `"`E" `CNK- GENERATOR COPY <br />