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X-*.t fe�)H 14. 14(.)U R EMh;KL;J!'NCX I NYIJI(Mklyl' !Jl" CAJLi ( ;eUb I 6ZZ—_IU9U <br /> 0 L'!t—-z U 0­4 u—L)—U u.:f 9 r:'ilypry 1 0 r;'A,-- V r J.'/U 08# 26.185 9- 39•-94 <br /> Please print or type. (Form designed for use on elite(12-pJlchr1Yp6,;1,1J.) ..! . Form Approved.OMB No.2050-0039.Expires 5-P,•,91 <br /> jj UNIFORM HAZARDOUS1 21.Generator's US E.PA IU No. Manifest Document No 22.Page Information in the shaded <br /> WASTE MANIFEST l areas is not required by Federal <br /> (Continuation Sheet) I*A 14 111 111.�If M.*I I JhAA of 7 law. <br /> 23.Generators Name L.StatManifest Document Number <br /> DIi'VIOBLIT I ON It Kt;I UN WKS 1' (.it i ARIJ t I t-1-0�) Y/ e7l <br /> \,4_M.State Generator's ID <br /> I(l.jUUIj Xj,:ALPY 1SLAKir" STUCIVI-ON, (.:A J52ij.J <br /> It+t 1 ,`lye, <br /> 24.Transporter Company Name 25.US EPA ID Number N.State Transporter's ID <br /> • O.Transporter's Phone <br /> 26.Transporter Company Name 27.US EPA ID Number P.State Transporter's ID <br /> 0.Transponer's Phone <br /> 29.Containers 30. 31. R. <br /> 28.US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Total Unit Waste No. <br /> =HM S, / I No. T Cluantity Wt/VOI <br /> a. f(U Wifue c,ciwoustikije !.iatlea (PeLruieum <br /> df-tit'lliaLe, ryel.ullexilnol) 121-i . 14 !)4 L 2oo r, U001 VT02 343 <br /> b. <br /> 1`4011-14.0,A IIf4ZaC(Ir11jr2, Wae;t,(, f,i ran icl. a I DM I <br /> C. <br /> G d. <br /> E <br /> N <br /> E <br /> A e. <br /> T <br /> 0 <br /> R <br /> 9- <br /> h. <br /> I. <br /> S.Additional Descriptions for Materials Listed Above T.Handling Codes for Wastes Listed Above <br /> a) .WFU J14jo - CLIN LJIV - C.66ANING SULVENTAIPWrX01,91.1h DISTILLATES i <br /> CYCLURUANUI, - IZV-h (85) 1 ff - b) VVQ CLIN 3905,3900 oil, V/ <br /> 32.Special Handling Instructions and Additional Information <br /> T 33. Transporter — Acknowledgement of Receipt of Materials Date <br /> R <br /> A Printed/Typed Name Signature Month Day Year <br /> N. <br /> S I I I <br /> o 34. Transporter _ Acknowledgement of Receipt of Materials Date <br /> A PrintedtTyp!td Name Signature Month Day Year <br /> T <br /> E <br /> R <br /> F 35, Discrepancy Indication Space <br /> A <br /> Y <br /> c11 r- fr)0V nP CTAT;: r%nPV <br />