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Pleasepfintorrype. Form designed!for use on elite12-itch axmer. Form Appmed.OMB No.2D560039 <br /> UNIFORM NAURDOUS WASTE MANIFEST 1 21.Werakr iD Number aPape M.MemkN TreYlea Nemeer <br /> (Continuation Sheet) <br /> 24,Gaac O Name <br /> Western Dental-OIC 245 <br /> 25.Pam"rlei I cownpuly Name U.S.EPA 10%nnW <br /> 26 TmMWM ComDoaYName NS.ER U)NumBv <br /> 27a 276.U.8DaTD , n(kq NPWB"IPPINName,W NCN ,IDN.bu, 22,Cpmuners 29.T,,, 30.Unh 31 <br /> NM and Padtlno Gmoa(H arty) k Typ am* W 1. .WaW Oaks <br /> o¢ <br /> a <br /> W <br /> 2 <br /> W <br /> 32.Spe Haodina,IM etalons and Additional InlomNtlm <br /> ¢ 33.Ti rmr AWIexkC raww! al ols <br /> P.n ,pad IV <br /> ,s Sl mra Yaa <br /> S IIVAVLI`/ <br /> x <br /> Pnrle kr of NMaWiiN <br /> P�kNNTypM Name SlpnmuM AIOMI ON Year <br /> 35 mssrapamY <br /> Y <br /> 0 <br /> 36.NmNaMwaste RepOd Mmlapemem Mmtmd Code liA.,mdea lm n»erdnusevm wtmens dls0aW aM rxyUirN <br /> do ssmmnsl <br /> 2 <br /> W <br /> O <br /> EPA Form 8700-22A(Rev.3-05) Prwious eddesm ass obsokte. DESIGNATED FAC4LITYTO DEST IXTION STATE(IF REQUIRED) <br />