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r <br />U - <br />Please orirtt or Nos. (Form Besioned for u'se on elite ( t 2 oitc' Wnter) • <br />Forth Aomaved. OMB No. 2050-0039 <br />EPA Forth 8700-22A (Rev. 3-05) Previous editions are obsolete. <br />C_)ll LI -Eq a`ib'v01 <br />DESIGNATED FACILItTY T ENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST21.//Ge''i, <br />(Continuation Sheet) <br />,r ID Number - - <br />L �{ 1 11(✓ L ! O` -ii <br />22. Page . <br />,test Tracking Number <br />0o <br />'24. Generator's Name - r <br />CA U 1.� C'c �c,1, Cl'G. <br />Number <br />25. Transporter_ Company Name <br />26. Transporter Company Name um er <br />27a. <br />HM <br />27b. U.S.0DOT Description including Proper Shipping Name, Hazard Class ID Number, <br />and Packing Group pf any)) <br />26. Containers <br />29. Total <br />Quantity <br />30. Unit <br />Wt.Nol. <br />31. Waste Codes <br />No, <br />Type <br />CGrrUSIVCIt UIci.hwQ iC-rI'I(fccQI)iGIN-G.5" <br />C J«11um 1-1+IC'F&rde..lycl-IA <br />(�)� <br />t.,nN &'u <br />U113;tcoCv PG� (Pr . ISV 1=-- Ha4Cfo3o <br />tbw-pt+e-CC+(ro51Ve Ctq�ti IGYcill�( Ilrkurrtgnr4,r1•U.`z <br />QA\j d(oC,hlc,rrGNC,cl,[`,c.1Ful-I(L.Rc\C1)iS,Ut)3axoq <br />(LIQ <br />x <br />p(''. C I-\3LLACLoN�- <br />AecUSGlsI.IOVlrli��(Urltvi'rSalWtSl�y <br />wlP, <br />x <br />cp)Cc I� ,via°(�) <br />00 <br />NTY)1)I LA't ILAO IIIRrCG}t`:., (�f'f'}- t-tf r1s, JdT 1.1 <br />x <br />Na uta o}U111 <erc,.14c,)(13r:cIjJkgS,.{q) <br />GU a <br />CQ` 5 <br />NI <br />'�" <br />I-Vylanchl�tl� �c�lt-t}t(,r151 glUrl ll�tlt(�G� <br />�.�> <br />�I� <br />Y <br />_ <br />` <br />0 4.4ix'rr 1 C 1 � kAii� i 1 U ��3, y �_ J-E+� 4 Ukl'1 :=},�r'mJaa� " €�'1• <br />..._. <br />•. • -.... <br />r ::.0 <br />1_11hun� I1ijpc;c-%ict',i )I 5.I)Un313cj !'C3IC.00 <br />1 <br />�1)` <br />10I <br />~. <br />(YIPrCUrU fCcrllurt)r11r11Tlai)uKl�iutPiLirlr`IttS),(7 <br />�( <br />Ut1 aEetq i1 (ere'. ) (ISG C+) QtNG <br />` <br />y <br />�}}er1P:, �r� Conlarltnc lx.lu�slUn� hycfrc,vl <br />� <br />N <br />I- <br />t'rG, -�I r Ui7'X.1�t PG 11 <br />GlqE it <br />k �4e <br />as1 <br />��� <br />OO <br />I <br />. <br />ef(I � ��c1ti , <br />X <br />1 <br />1cv <br />(fr'154 C CH;145V'1Ci) <br />olow,> <br />N' <br />F,U5[e.((Cil hl hway} 4-I.I NA 1325 <br />GII <br />�( <br />S•'�x �, <�'� ' i33) (17F , C: h a4ulr�S'.l.) <br />� � <br />� <br />UU <br />(X>I ( <br />I�- <br />32. Special HandlingInsWctions and�Qditional Information <br />5•)Cl1 tL4 C de -k 3U DF (n)Ciiaf-w&A k 3(_D� I)t\P're:.e l� x nI�CF j.1 C1{145Iv <br />G tl+ Wtt,-b�l }-X. 3C.1r ir•)C'W4c+c��� �--X 3o 1)F ll)C1' ; b <br />of <br />Q3. Transporter Acknowl <br />d ment of Receipt of Materials - •" - <br />H <br />'ntedQ'ypede I <br />1 <br />tgnotur Month Day Year <br />t A.tm 5ON <br />0 <br />d <br />Z <br />34. Transporter Acknowedgment of Receipt of Materials <br />PrintedFrod, Name e Signature Month Day Year <br />z ,u <br />9%dis'drepan- y Me" z <br />I <br />`S6, Hazardo s <br />as f 11 Management Method Codes (i e • f he <br />L L <br />us waste treatment dl 'o al, and <br />cycling sysl6m's)' <br />V" <br />1 ti <br />Ij c <br />l <br />o <br />Cf ., <br />EPA Forth 8700-22A (Rev. 3-05) Previous editions are obsolete. <br />C_)ll LI -Eq a`ib'v01 <br />DESIGNATED FACILItTY T ENERATOR <br />