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Please pn4 or typo. ,_ ; Form( roved.OMB No.2050-0039 <br /> UNIFgM HAZARDOUS WASTE MANIFEST 21.Generator ID NumberP a [23.Man1lestTracking Number r <br /> (ConlfhuaUon Sheet) �M�Z 6�F B } 01 445632 JJK <br /> 24 Generator's Name <br /> Latwe me Lhfllssrr'dorlllF mmonal Lob SM 30D as h AWA P.O.Bon SA/L-M three`r fare CA 94551 <br /> 25 Transporter Comparry Name U.S.EPA ID Number <br /> 26.Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S,DOT Description(mcluding Proper Shipping Now,Hazard Class,ID Number, 28.Containers 29.Total 3Q.Unit <br /> HM and Packing Group(if any)) No Type Quantity Wt Nol., 31.Waste Codes <br /> 45.NbrFIMIA hamrikl>us WMft timed(non-PGB WWAO DWO029-1 1 Divi 174 P <br /> 7�3 <br /> 4L f &l -RMA haNdOW W MIU,KINd(burn PR lash)seri-- S4.1 7 DF 128 P <br /> 181 <br /> 47.i'1g1 •RCRA trdatu mob, [rlfaQarcaa l d wl 1 V Z3 P <br /> 133 343 <br /> o r,. ►� wrus�,lE�add(all�y���y1:a1 fin) 1 DF 16 P <br /> DOPUM 1LU 343 <br /> z <br /> LU 45.Non-RCPA hmlladatrs rot(,�d Inoo-PCB WkSW 2 i DM 254 P <br /> l <br /> 223 <br /> SDI.N Rpm►hum* s Waft xM(dam and sud ) 1 DF . 2l) P <br /> DOP0104-I <br /> -� 172 <br /> 5L WaSM CarlesR Tw"m rmcif y,ORM-D(mme b)[ERG 1711 1 DF 47 P D00$ I]p07 DOW <br /> DOPM12-i <br /> 331 <br /> 11 <br /> a WaSt%Qn=W MUnOdI4.ORM-D(I[IMI4 )[ERG 1711 1 DF 54 P Ute. Do1R DQ3 <br /> OOP0112-1 <br /> 741 724 331 <br /> 32.Special Handkng Instrudions and Additional Infamration <br /> 33.T aneporter nl of Recoo of Materials <br /> r PrrintedfTyped Name Signature, Month ay Year <br /> i 34 Tra A3n-W-pqmentofReceiPt of Malerials <br /> PnnledlTyped Name Sgnafure Month Day Year <br /> 35.Discrepancy <br /> V <br /> U <br /> S Waste Repan analgnt Method�C040(i.e.,codes /bps waste treatment, <br /> A17�rspasal/� tems�� ,, fI / / <br /> J. <br /> Uj <br /> 50 <br /> EPA Form 87DD-22A(Rev.12-17) Previous editions are obsolete. - DESIGNATED FACILITY TO GENERATOR <br /> t <br />