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1A <br /> far use on stile 12 'iob t. Form rover!.OMB No,2050 0039 <br /> Wa4STE MAINIPE$T 21 for Number .Prad� R3. t Yraekinp umber <br /> v. <br /> tlnuatiae;3tieell 2— d-- <br /> gpr'B Narrea . <br /> U.S.EPA ID Number <br /> 26.Transporter ny N <br /> U.S.WID Number <br /> 26,Tra+tspoaar Company None <br /> 27s. 27b.U.S.DOT Description(rrdudirrg Proper S*ft Name,Hazard Gaal,ID Number. 26.ConW-S 29.Total 30.Udt 31,Waste Codes <br /> NM and Paddng c (8 any)) No. QuaMby WIN& <br /> 32.Special Handkg hail—Mns and Addi"l Information <br /> 33 7 Admowl of R of Maladals <br /> yi�Nmae .. �re +o y YeDayas <br /> I <br /> 34.T of R 'g of Mamw <br /> Nara Month Day Year <br /> 35 Dtecrepeaoy <br /> 36,Hazardous Waste Report Management Me6wd Codes(I.e.,codes for hazardous waste treatment,disposal.and re systems) <br /> EPA Farm 8700.22A(Rev.3.05) Previous editions are obsolete, DESIGNATED FACILITY TO DESTINA11ON STATE(IF REQUIRED) <br />