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riease <br />not or WK I Wrn des! ned for. use on elite 12• itch etivrilet. Form Approved. OM3 No. 2050-003D <br />UNIFORM HAZARDOUS WASTE IWANIFES <br />{Continuation Sheet) <br />`2 A Generator l r <br />22. Page <br />23 st Tmckln .Number <br />24. Geharawrs Name <br />f . <br />25. Transporter Company Nam , - US EPAI➢Number <br />U.S. EPA 10 Number <br />26. Transpaner _: Company Name <br />27a. <br />HM <br />27h.. U3. DOTDescnplwn (iriclAng Pmper Shipping Name. Hawd Class, l0 Number, <br />-and Packing Group (Efany)) - <br />28. Cienldlners <br />29. Total <br />- <br />-quantify _ <br />'30. Unit <br />WtNol:- <br />31: Waste Codes <br />No. <br />>Type ; <br />ji <br />l <br />W <br />z <br />W <br />C7 <br />i <br />r <br />32. Speed Nandlhg Inslntclions and AdWorial Wormafiorr - <br />33. Trans - :• AckmMed mentotRecel�tofMatertals <br />CL. <br />Pontad+Typed - -. Sig Month ;Oay, Year <br />z <br />3.4 -Trans Fhdumve entatAeceitoi6gatauals <br />Printed7Typed Name Signature Mono Day Year <br />LeiV <br />Q <br />rl <br />0 <br />35: Piscmpancy <br />w <br />'g- <br />LM1 <br />36:HwxdousWasleRepedManagememMalhodCodes {i.e.;codesforhazardcuswastetreatment, disposal, and recycling M.tards) <br />rn <br />w <br />0 <br />