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06/17/2009 10:30 5105811102 JACK EDWARDS PAGE 02/03 <br /> f <br /> i <br /> 4 <br /> I <br /> t'loaRa print or type.(Form designed for use on elite 12.Itch lypewriter.) Form Approved.QMB no.20S0-0039. <br /> I <br /> UNIFORM HAZARDOUSat generator's US EFA ID No, ManifeSf poCurnenl No. 22Pe$9 ,fnformallon in 111e 9h+dr3d <br /> ! WASTE MANIFEST n @teas is not;roqulrad by Federal: <br /> Continuation Sheet <br /> !aw <br /> 23. Genorator's Name L State,Man,Ifeslbooumcnt:Numbor".:;`:'. : I <br /> I <br /> I <br /> ansporteU C.�' amps y NBme ,p� PA 117 Numbor N, Sta;eTtsneporter's ID ; <br /> P Sta7tarlsportarteTYr <br /> 26. Transparter_,. Company Hama 27.US EPA ID Numner ansporter s JD <br /> Q:.::Tran�parter' - <br /> 29.Containers 30, 31 <br /> B,US DOT Description(Including Propor Shipping Name,Hazard Class and ID Number) Total Unit Wtiste,;Nor:; <br /> NM No. T e Quantit wtvol <br /> 1 <br /> i <br /> d. f <br /> Nr <br /> T <br /> O ' <br /> R <br /> f? <br /> 1 <br /> S-Additional Descriptions for.,Nfatsriai¢L13ted Above T :Handlfna Codes for•Wastes Listed Above <br /> l <br /> i <br /> 32.Special Handling inatruoltons and Additional formation <br /> i, <br /> r 3.'rransportsr _ Acknowledgment of Recolpt of Matorials Date <br /> A t®d pad Namo �Reoeript <br /> 5tgn rg . _ Mn Day Year <br /> N <br /> 4,Transportor- nowledgeE Printod _.. .. -,.,.... .. . ... <br /> (Typed Namo Signature Month nay Year <br /> R I <br /> A 5,Discrepeincy Indication Space l <br /> 0 <br /> i <br /> L <br /> EPA Formt1700-22A (Rev`g•9ilj PreWou atlitMnlsahsolste ORIGINAI_-RETURN,TO GENERATOR <br />