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®:Form des ned for use on elite v-p itch typewriter. <br /> Form Approved.OM8 No,2050-0039 <br /> E MANIFEST 21 61W10 Number <br /> RDOUS WAST �� 22.Page 23.Manfttjest Tracking Number <br /> NIFORM jContineatlon Sheet) 4lJvtJ �2- - u � ` S <br /> 24.Generators Name <br /> t <br /> U.S.EPA ID Number <br /> 2s.Transporter CompanyNama� , I � {.�,,�,+� L 3 <br /> U.S.E AID het <br /> 20.Transporter Co npany Nacre <br /> 27s' <br /> 2&U.S.DOT Desalptlon(du ft Proper shipping Name,Hazard Claes.10 Number, 2B.Centaurs 29.Totes 30.Unit 3 t.Waste Codes <br /> MM and Packing Group Cd any)) No. Type 0rendty VVLM- <br /> a <br /> O <br /> zW <br /> ttJ <br /> t'a <br /> 7278pedaf ftWJM Instructions and Additfarel information <br /> 33.Transpoder mentolReoet tofMaterials Month Day Year <br /> U P• riled Name <br /> o r of112V QS <br /> Z34.Tra er mart of Receipt of ass Month Day Year <br /> Pnned/Typad Nam Signature <br /> 35.Discrepancy <br /> J <br /> 4 <br /> W <br /> fa 38.Hazwdorm Waste Railer Managemard Method Cogs(1.e.,codes for hazardous waste treatment,disPosei,and raeyc%systems) <br /> CV <br /> w <br /> 0 <br /> EPA FortnB700.22A(Rev.U5) Previous eMons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />