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Please print or Form designed for use on elite 12 itch writer. Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST '21 • Generator ID Number 22, Page 23. Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24, Generator's Name <br /> CYS • #9261 <br /> U.S. EPA ID Number <br /> 25, Transporter Company Name <br /> U.S. EPA ID Number <br /> 26, Transporter Company Name <br /> 27a, 27b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 28, Containers 29, Total 30, Unit 31 . Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity Wt.Nol. <br /> S; U61281.1 , - Waste ToxicI solids , orgagic, :; n . .o . •s i : CF 00002 P 311 D007 D010 <br /> ( Chromium , Selenium ) , 6 . 19 PG II , ERG# 154 <br /> 6 . UN3249, Waste Residue Last Contained ; i CIF 00001 P 311 P001 <br /> Medicine , solid , toxic , n . o . s . ( Warfarin ) , <br /> 7, 14on RCRA hazardous waste ,: - liquid ( Regulated . 2 DF 00197 , P 331 <br /> Liquids ) , <br /> O <br /> lowW <br /> Z <br /> W <br /> 32. Special Handling Instructions and Additional Information <br /> 5 . 100196 ( RX - Toxic Solids ) 6. 101079 ( Residue weight does not <br /> , exceed 0 .: 0436 lbs ) ; : CNT *. 35 7 . 102979 ( State Regulated Liquids ) <br /> 33. Transpoder . AcknovAedgmentof Receipt of Materials <br /> F PrintedfTyped Name Signature Month Day Year <br /> O <br /> a <br /> Z 34. Trans iter AcknoW meet of Recei t of Materials <br /> g Printed/Typed Name Signature on ay ear <br /> !•- <br /> 35. Discrepancy <br /> J <br /> U <br /> LL <br /> D <br /> Q 36, HT <br /> Waste e n Management Method V <br /> .a cZ7// <br /> de or hazardous waste Ueatme t, di posal, and recycling systems) <br /> Z 1. <br /> W <br /> c <br /> EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br /> 8700-22a 12v3 CAL20090641 58866 040911642 M PD081617 SD081617 <br />