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Please print or type. , � t. /-'�Ci ti C� Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21�neraw iD Nu�2 22 '2 23.Manifest Tracking Number� �� <br /> (Continuation Sheet) <br /> 24 Generators Name I....Umwwe MUWW Lob We 3W on behW 4f US NMA <br /> L1 /17 44 <br /> 25 Transporter Company Name ti <br /> U.S.EPA Ill Number <br /> �` Company Name /� U S.EP ID Number <br /> 25 Transporter Pa Y /�.�s S. <br /> 27a 27b.U.S DOT Description(ndudirg Proper Shipping Name,Hazard Class,ID Number, 2B Containers 29.Total 30.Unit 31 Wads Codes <br /> HM and Packing Group(il arty)} No. Type duanfily wt./vol. <br /> Io t,oroi rrlt}.2.2[ERG 1261 turd:LC 2-s <br /> 331 OM I( <br /> 5.lJNIU78,Waste, mrtt pm,n4A( QUWY CY 89 P <br /> MxdU r*0th4W}, 2.2 IERG 12A LLNL-=-1 <br /> 331 OM 8Et11 <br /> 0 <br /> w <br /> z <br /> w <br /> 0 <br /> 2 Special Handling Instructions and Additional Information <br /> 33 Transporter A&r0*4);merit of Receipt of Materials <br /> W PT.tY ed7T Name Month ar <br /> r —` _�f" r Signature h t1 I D� <br /> 34.Transporter +fir menl of Receipt of Materials i <br /> Printedlfyped Name Signature 2 , r Month Day Year, <br /> 35 Discreoai <br /> J_ <br /> V <br /> a <br /> O <br /> a36 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.disposal and recycling systemsl <br /> rn <br /> w <br /> 0 <br /> EPA Form 87DO.22A(Rev 12-17) Previous editions are obsolete DESIGNATED FACILITY TO GENERATOR <br />