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Please print or type. Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121 Generator ID Number 22.Page-x 23.Manifest Tracklnp Number <br /> (Continuation Sheet) C�4-Z�j b t Q7 Z Z go $ ()? <br /> 24 Generatoes Narne <br /> L4wraaee.n,. Ar'wervlfor.c Il{y 6'a-a A" S.LdL 30o SAME <br /> 25.Transporter 3_ ComparryName Clean Harbors Environmental Services U.S.EPA IDN00039322250 <br /> 26.Transporter Canparry Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(irdu k g Proper Stong Name.Hazard Ctass,ID Number 28.Containrers 29.Total 30.Unit 31_Waste Codes <br /> Htd and Padarq�4(if wq)I No -ype Quar" MAtiol <br /> a <br /> 0 <br /> �a I T V <br /> oil <br /> x <br /> w <br /> G9 <br /> 32 Special Handling Irnstructicm and Additional infatuation <br /> 33.Transporter meet of Receipt of MatCnah <br /> w PnntedrFyped Name 54nature Month Day Year <br /> o P. James BakK*An f <br /> a <br /> i 34.Transperter AcknWedgment of Reo*of Materials <br /> PrintedlTyped Name Signature Month Day Year <br /> 35 Discrepancy <br /> J_ <br /> C? <br /> 0 <br /> LU <br /> tR 36 Hazardous Waste Repon Management Methatl Codes(i.e.codes for harardous waste treatment,disposal,and recycling systemsj <br /> !U0 <br /> EPAForm 870(Q2A{Rev 12-1� Previous editions are obsolete DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />