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Please print fir type.(Forin designed for use on elite(12-p)tM)typewriter.) Form Approved.OMt3 No,2080-0039 <br /> UNIFORM HAZARDOUS i4IASTE MANIFEST 21 Goncralor ID Number 22,Paga 23 ManlfaetTrack1k�inq}lum`bborr <br /> (Continuation Shout) 4 +•-_r.�ar_r E <br /> 24.GcreraiceNamo <br /> 25.Transpartor_� — Caropanyh'amoi Ai u U•S. •PAIDNumber <br /> 26. Transporter Company Namo <br /> U.S.EPA rD Nvrrber <br /> 27a. tib.U.S.OOT Deecdptian(1nUud,ng Proper Shipping Name•1{azurd Crass,lD Numtsv. 28.Conlalrmt, 29.Total 30.Unil <br /> l48 and Pack ng Group(1 any)) 3t,;h'asto Codes <br /> ke. T}Tr" Qugntip Pltnot. <br /> U, S <br /> li t <br /> L'7 <br /> DEC 2 2 2015 <br /> ENVIRONMEN — a <br /> (-1!711TUncr)hOTA4r_.n,..- -- . ......__._..... <br /> 32.Speuai I iandling Inslrudi,ns and Additonal tntarmation <br /> 33 Ta:s an r,_. _Atknmtiedriyn(orRexip[o'M2terats — —_ __ <br /> PrinledlT Namo S gnatu e r,lldh pay vcur <br /> ell- <br /> � 34.Tmn;p.}rter,_,-_,-�AcY,no;tiiedgment Ot Re al (o(fda!ariaL V <br /> P nle LRyp d Name Signalure hisalh Day Yoar <br /> 5.Discrepancy — - - <br /> _J <br /> U <br /> d <br /> lL, <br /> lLr <br /> M.hazardous Wasle Repoli Manngemerl Methal Was(La.,caries far hazardous waele treatment,disposal,and recycfng systems) <br /> t� <br /> in <br /> w <br /> EPA Form 8700-22A(Rev,3-05) Previouse(Iitioh5are cb5o!ete. DESIGNATED FACILITY TO DESTwA' oN, STATE(IF PEOUIRED) <br />