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Please print or type } +��+ `9 Form Approved,OFA9 No.2050-0039- <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 Generator 11)Number 22 Page 23.Manifest Tracking Number <br /> (Contlnuatlon Sheet) <br /> 24.Generator's Name <br /> LP1WRTQCC LWL-f1,M0M NhZ1171�AL --��OSRrtv I <br /> 25.Transporter _ Company Name Clean Harbors Environmental fiArvices u5 "AID VAD0 19322250 <br /> 25.Transporter Company Name <br /> US EPA ID Number <br /> 27a 27b U S.DOT Description(including Proper Shipping Name,Hazard Ctass ID Number, 28 Conta:ners 29 Total 3U Unit <br /> HM and Packing Group(f anyl) No Type Quantity Wt'do 31 Waste Coda <br /> i <br /> I <br /> O <br /> TPO <br /> W I <br /> Z <br /> W <br /> L7 � <br /> I I <br /> j <br /> ' ' t <br /> 32 Spe=.al Handl ig Instruc-ons andAdd-Csnal Information <br /> 33 Transporter_ CAcknowled ment of Rraipt of Materials <br /> W PnntedTyped Name Sgnature f,lorth Day Year <br /> JANA WILLIAMS l <br /> y 34 Transporter_..Acknowledgment of Receipt of Materials <br /> PrintedlTypedName YSignature Mom Day rear <br /> i- <br /> 35 Discrepancy <br /> J_ <br /> f.) <br /> U- <br /> G <br /> W <br /> Q 36 Hazardous Waste Report Management Me'hed Codes(i e. codes for hazardous waste treatment,disposal and recyvirg systems! <br /> x <br /> C7 <br /> rn <br /> rj <br /> C <br /> EPA Form 8700-22A(Rev.12-17) Prev.ous ed-bons are obsolete. DESIGNATED FACILITYTO GENERATOR <br />