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Phase. Inkor . Form deal ned for use on elite 12- itch writer. <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 Generatu4 ro Number <br /> (Continuation Sheet) /� 22.Page 23.Manifest Tracking NumMr Form Approved OMB No.20500 <br /> 24.Go he Name 9t•/0 5 7 <br /> 15. Transporter 3 Company Name <br /> {"-`—fa fj U.S.EPA ID Number <br /> C� Q I�(��O /� <br /> 28. Transporter Company Name . .If < �' ��5 Z C7✓ <br /> U.S.EPA ID Number ✓ -'IC3 <br /> 27a. 27b.U.S.DOT Desorption(mdodi Pm Shi i Nam¢,Haazrd CI ID Number, <br /> HM and Pacto Group(d any)) PP n9 , <br /> 18.Container 29.Total <br /> 30.Unit <br /> No. Type Duantity WI 31.Waste Codes <br /> i <br /> i <br /> i <br /> � s <br /> r <br /> r <br /> l i <br /> i <br /> I <br /> � t <br /> " ........... <br /> 32. <br /> i <br /> 1 <br /> 32.SPecial Handling Instructions and Add <br /> Banal Information i I <br /> 33.Tran merit 9P 't of Materials <br /> f Print Ped Name <br /> K <br /> i 1c <br /> Sgnature , <br /> / !' Month Day Year <br /> = 34.7 Acknow9e <br /> Pd merit of Rec¢i i <br /> rintedrTrped Name Materials -\ ••-� q .Y <br /> ~ igreWre i <br /> 35.Dam panq ort ay our <br /> J ` <br /> a <br /> LL <br /> W <br /> 38.Hazardous Waste Report Management Method Codes(i e..atlas lahawrdous waste Irealment,tlis <br /> n pawl,end recycling systems( <br /> u <br /> r ' <br /> A Form 87'lil(Rev,3-05) Previous editions are obsolele. <br /> "Ja DESIGNATED FACILITY TO GENERAT(1I +v <br />