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Please <br />print or <br />W. <br />jrVrM designed for tree on elite 12 <br />itdttypewriter.1 <br />Form UpMved. <br />OMB No. 2050m m39 <br />UNIFORM HAZARDOUS WASTE MANIFESI <br />21. Generator ID Number <br />22 Page <br />23. ktanHast Tracking Number <br />(Continuation Sheet) <br />CAR 000 271 155 <br />2 <br />018588741 JJK <br />24. GaneraWs Name <br />RITEA)D #00434 <br />25. Transporter Company Name U.S. EPA ID Number <br />26. Transporter Company Name U.S.EPAIDNumber <br />27a. <br />27b. U.S. DOT DescrWon CatdudlM Proper Supping Name, Hazard Class, 10 Number, <br />28. Containers <br />2g. Total <br />30, Urat <br />3t. Waste Codes <br />HM <br />and PadGng Group Cd any)) <br />No. <br />Type <br />Ouaniity <br />WL/Vols <br />05 NonwRCRAHaz rs {+fie, UV". (C&Mmw Pf"WS) <br />006 <br />OF <br />OOM <br />P <br />331 <br />to SM l <br />X <br />01 UN3248r" Nb6ds 1153itrl tov nA.S.DOI <br />P <br />U002 <br />D801 <br />r , <br />jeal), P61111 ERG *131 <br />DUWFUM� <br />311 <br />1w <br />wool <br />Toxin N.0.1s_ (Wa2twin, Coasmaffin), 8.1, Mi, ERG #151 <br />sit <br />LU <br />X <br />MUM, VMW NkdW,4 Oal, Mix ERG #151 <br />---66V <br />OF <br />em <br />P <br />POT1 <br />3 <br />I.7I B 777 3 7 71, 7 2 <br />.l <br />Itt rdc am'obattam ' � '. d �cttist4�d �C��t>;! t�xs-1t+3toEt� Sxs�d 7. F+�X02! Fttnatis� F't�tc:tr�c�Roc�tl; <br />rS. �� # tY^LS: Eked, dY,s&4 aa:t �ucreQd .;v. �rxptt: 21 .�. ��K1ti J F#'� • DA � <br />� <br />33. Trans Adsrwv. of of tdatariaks <br />PhntedrTyped Name Signature Month Day Year <br />O <br />OL <br />z <br />34,TransXder.AckrmiedgmentetRecelplafMatefiah <br />Prinled/Typed Name signature Month Day Year <br />f- <br />35. Discrepancy <br />v <br />W <br />Wam ms2e Report Management Nod q"32 codes forha:ardous waste lffir°Qn""j, and reqdi"5 systems) 108 11141 09 H141 <br />a <br />c� <br />w <br />cy <br />EPA Form a7m0.22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACIL11Y TO DESTINATION <br />STATE <br />(IF REQUIRED) <br />