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Please pribor typo. 3 F Form Approved.OMB No,2050-0039 <br /> UNIFOV HAZARDOUS WASTE MANIFEST 21.Generator iD Number 22 <br /> -�3F 6 23. nifest Tracking Number <br /> (Continuation Sheet) QQ$�Z pF 01944602IJK <br /> 24 Generator's Name Lawence Uver orp NaUwW Lab Me 30D on beW of LI S N NSA P.O.Box 9DB f L 786 LhlBtmwe CA 94551 <br /> 25 Transporter Company Name U.S.EPA ID Number <br /> 26.Transporter ._. Company Name U.S EPA ID Number <br /> 24 27b.US DOT Des#1ion(including Proper Shong Name,Hazard Class,ID Number, 2B.Containers 29.Total 30 Unit <br /> HM and Packing Group(if any)) No. Type Quantity yn,rya. 31 Waste Codes <br /> 35.Norm-=A hmmirdats v nft!hW(aRrCdM s I DOPOM 1 DM 189 P <br /> 1 <br /> 331 281 <br /> 36.Nbn-RCRA ha to wage U"(SMUM faws )DOPM20-1 1 DF 18 P <br /> 331 <br /> 37.f+ RC PA hmrdt=wasdt,w0d M IXNQ12&1 1 DF 5 P <br /> 331 <br /> 3 L*wrk.RCRA hunism woo stdid Wk Mrdww,ptritty) 1 DF so P <br /> DOP0120- 331 <br /> 1. <br /> 3%Ntut- MA hittza nkK a V*d€sue 4 DOMID 1 DM 115 P <br /> i <br /> 331 <br /> JIM Nat Ilr-=AA hRRO S wm ts.WIM W&MW MCIM t)DCaPM 1 1 DF 5 P <br /> 331 <br /> 41.Nix -! l hmtaad as wuft SON(OMNIS Cw tt tnatxmd with 1 DF P <br /> Dshckm hYdroewbwa) 44.1 <br /> 22,3 <br /> 41.Nor1--RCAAtt: niMn WA9111i, 14 d(eff+ &Need)DDPDDB&-1 Z D 330 P <br /> 3431 <br /> 43 Roar-RCRA hM=d=wNi ts,t Md(KWI-ptt b c>f ci#tala}DOPOM 1 DF 75 P <br /> i <br /> 2?3 <br /> 44<NOW-RCRA ha mda s wmte,sand irty txmtemburted with 3 DM 405 P <br /> ptdmlr>aurt�)DOPM4.1 <br /> ZZ3 <br /> 32 Special Handling Instructions and Additional information <br /> W, 33 TranMur,er AMNLedgmerd of Receipt of Materials <br /> F Ponte&Typed Name Signature Month Day Year <br /> o� <br /> Z 34 TrampoAer rnentof of Materials <br /> Prantedlfyped Name Signature Month Day Year <br /> r- <br /> 35.Discrepancy <br /> rs <br /> LU <br /> a <br /> is <br /> � 36,Hazard us Waste Re MaggAnerit Metlmod es(l.e r waste��tmer .d _ grmq, yslems) <br /> EPA Fortar1�7W22A(Rey.12-17) Pre,Pious s are obsolete. / DESIGNATE F ILITYTOGENERATOR <br />