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Please print or type Form Approved.OMB No.2450-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121,Generator ID Number_ 22 Pao 23.Manifest Tracking Number <br /> (Continuation Sheet) <br /> 24 GeneratoesName <br /> C�CL L.���CQ. L.tV��l""1�?Cy����'(��ti -IC��� �..���CZ�►"C`��L� c1 I�[.-L' -7T'y <br /> 25 Transporter Company N3m1 �� U S.EPA ID Number <br /> 26 Transporter Compary Name J (� US EPA ID Number <br /> i h1 <br /> 27a. 27b.U.S.DOT Description(includ'.ng Proper Sh,pping Name Hazard Class,ID Number 28.Containers 29.Total 30.Unit <br /> I I and Packing Group(if any)) No. Type Ouantity Wt]Vot. 31 Waste Codes <br /> H <br /> \` 1 <br /> a <br /> tx r <br /> w <br /> t <br /> I <br /> �4 <br /> 32 Specia,Handling Instr Cons and Addboral Informataon <br /> d3.TrartSooRor _Ackno%*d3ment 0 Receipt of h!ateria!s <br /> LU Psnted,Typed Name f 1 _ Sgrwnxe ,,y hlonar pa! Year <br /> a !; �j f i�/ f! '� �'~/�f � ' ,% �I/��/ �r� �•Z�c-� C� �Y / y <br /> s 34 Transponer__. .._Ackno,.vledgmenl of Rece'.Ft of Materials <br /> PnMed.Typed Namg a Signatr�re�:_f r y, frlor f]aX Yex <br /> 35 Dwrepancy <br /> 1 <br /> U <br /> a <br /> C2 <br /> a36,Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposai.and recyckng systems) <br /> z <br /> i9 <br /> m <br /> w <br /> EPA Fdm 8700.222A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />