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1"rw[ l M <br />PleasA mint nr tvne. (Form designed for use on elite (12 -Ditch ..uewriter.) <br />Fnrm Annrnved OMR Nn. 9n5n.nnm <br />EPA Form 8700-22A (Rev. 3-05)'PreVious�pogong, ar4absolete. DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />121, Generator ID Number <br />22. Pa -' "" <br />23. Manifest Tracking Number <br />(Continuation Sheet) <br />IA - <br />'. e�EL <br />24. Generat&s Name - <br />i <br />J.6 tVA uum er <br />25. Transporter Company e! , - - _ — <br />t r C ! r l �. <br />Number <br />26. Transporter Company Name <br />27a <br />27b C) $. DOT Descnption (including Proper Shipping Name, Hazand Class, ID Number, <br />26. Containers <br />29i Total <br />"3q Unit <br />y 31. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (9 any)) <br />Quantity <br />wt./Vol. <br />t rT�-1-T <br />/ <br />X'{S.'�illfti <br />'i lEFt). 'rFl. P 114._ <br />r <br />IF <br />t <br />0,or c,stve c -t 1djAc,n+c.,(nor r)1C.jKLI S..81 <br />�( <br />t�,�Nc�Sf�rw+�3. <br />Utl3QU G.. .'!l Dt2c�t u tIOU <br />v'. <br />F <br />-, a <br />i� <br />I <br />o <br />Riil�C�►JIuYYi NiFret►� �f'rFtltz.�r5 S.I NAalr;7 <br />, <br />(e rc�-.l4Eo )t P CHQ43)44) <br />� <br />1� <br />Istii�rtefdr r011400nlrtc pb{cd,(um hydrotnN <br />SU(Kt,6,un.3o�8,c�G3Z 'cPr�c� t�'UC�a ��+ayn444 <br />�t71 <br />� <br />ill <br />� :-� <br />J'�I�s <br />I <br />.. <br />RQ Polr-14LORWnfei� NPI-(cnlyj:� q uf)--a31,5 P6 <br />Q. <br />y <br />/` <br />(wi oCS&rLJIC(✓ .; 1`J-0.1 )(!n15 1 i )CC 14ago%35 <br />-)W <br />`b <br />iac <br />4--T <br />32. Special Handling Instructions and Additional Information <br />s} c a(Pw. DF ClOqU,,alb <br />, Z>iLAq i oaF Ci-X.Na4icu l axsia)C,Haoac')six b <br />O <br />33.Trans rter AcknoWed me tof Mptof Materials Y 11Of <br />PnntedR ed N@me ` { 9nature r ! Y ear <br />l10q <br />. yn ` / <br />1631 <br />0 <br />a <br />i <br />34. TransporterAcknowled meritNRecei tMMaterials <br />Printedrryped Name SIgnature Month Day Year <br />H <br />S <br />35, Discrepancy a <br />'` l"';3 6k'pu k i Ir, ;f�� ,n,zS.� x�t 1ti)} I >vfc�r�,l , 255��r. .ttrt, -"04 <br />iQ <br />o <br />i <br />36.Hazi "s p s ge tMethod C (i`Ce ha allo St treatmenLd IsaC <br />�rjfrg systems) r -(A' <br />..� <br />y <br />W <br />Q <br />EPA Form 8700-22A (Rev. 3-05)'PreVious�pogong, ar4absolete. DESIGNATED FACILITY TO GENERATOR <br />