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I ; <br /> I <br /> Form Approved.OMB Na 2050.0039.Expinrs 9-30.94 i <br /> UNIFORM HAZARDOUS 21.Generator's US EPA ID No. Manifest Document No. 22.Page Information in the shaded <br /> WASTE MANIFEST f�f�,D 4�j 6(� -s 0 ; U I Z areas is not required by Federal <br /> (Continuation Sheet) a d(c�� � r law. <br /> 23.Generators Name L.State Manifest Document Number <br /> 063 �L <br /> /�dAseju � �� j„ 926,961 M.State Generator's ID <br /> qq 24.Transporter Company Na �C 25.US EPA ID Number N.State,Trangporters iD <br /> GC R Ot 1 d►tS i iQ�� 2 6, f o.Transporters Phone _ 3 '73 <br /> 26.Transporter Company Nam 27.US EPA ID Number P.State Transporters ID <br /> Q.Transporter's Phone <br /> 29 Containers 30. 31. <br /> 28.US DOT Description(including Roper Shipping Name,Hazard Class,and ID Number) No. Type Total <br /> A10' Waste No. <br /> a. <br /> b. <br /> C. <br /> c d. <br /> E <br /> N <br /> E <br /> R <br /> A e. <br /> T <br /> 0 <br /> R <br /> f. <br /> 9- <br /> h. <br /> i. <br /> T.Handling Codes for Wastes Listed Above <br /> Additional Descriptions for Materials Listed Above <br /> 32.Special Handling Instructions and Additional Information <br /> T 33. Transporter` Acknowled ement of Receipt of Materials Date <br /> A Pr' yp Name //� �/^r� v S' ure i cC IMonth �y Year <br /> N Y1� `�r` J�`�/� <br /> S <br /> P <br /> 34. Transporter,_ Acknowled ement of Receipt of Materials Date <br /> T PrintedrTyped Name Signature onth Day Year <br /> E <br /> R <br /> F 35. Discrepancy Indication Space <br /> A <br /> c <br /> 1 <br /> L <br /> I <br /> T <br /> Y <br /> EPA Form 0700-22A(Rev 9-88)Prevmus editions are o0sobte. <br /> ORIGINAI—RE T TURN TO CEf`!ERATOR <br />