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type. Form designed for use on elite (12• Itch ewritec Form A roved: dM6 No. 2050-0039 <br /> 22. Pae 23. Manifest Trac. Ing Number'"' ' 'y <br /> SRM HAZARDOUS WASTE MANIFEST 21 : Gen tot ID Number 9 <br /> (Continuation Sheet) S¢ ? /} '7 t:� 4 <br /> . kN <br /> Generator's Name •, ' <br /> ( 0*1yEi= VO � �'77GIY h IN rrul' 2On/ <br /> SpU rc �tS 5 oar . . C'/�T%N � Sverz �► �v� t� c <br /> T r 4 5 • LagU.S. EPA ID Number <br /> 25. Transporter . Company Name <br /> U.S. EPA ID Number <br /> 26. Transporter Company Name 1 <br /> r <br /> 27a. 27b. U.S. DOT Description Qndudng Proper`4-*'ng Name, Hazard Class, ID Number, 28, Containers 29, Total 30, Unit 31 , Waste Codes <br /> HM and Packing Group �f any)) ` No. Type Quantity WLNoI. <br /> A/ aNI yu 1447.9nroov (AIA S ;2� L /Ct.� r ,J i <br /> r <br /> 1VM/ jUrzA j+og0zA 00645 wAs L� <br /> A6S0913EA"7/0ri ) <br /> lOhx<: 'l C1tF, / j` } 7A (wOOL/ S WA S7"r L 10 L411a <br /> 40 <br /> �4Dt� sS +✓ES � I 04� i '. <br /> 1 <br /> o <br /> a StojtFACTANT1wAi VIZ) F 67J Z 1 <br /> wE <br /> Lu <br /> r i <br /> i <br /> i <br /> 1 i <br /> i <br /> I <br /> 32, Spec <br /> 5 SL(40(7E /01r. - Ar9444r /"710bw3 - r% j Sj ;Lx55 <br /> G A• iss0 � r3srrr/v , c � ft /* 100 g10 $ L/ W sc. t Q yx5* S7cj / } C� u!u Ctq,4N5t2 - 19i004)fV �7410,1 � <br /> �� c (� AOHESIV S - 1qnj7 # Lr1yti9' 9 - Ci° 1x s`� / Cm , ; <br /> 33. Transporter Acknowled ment of Receipt of Materials <br /> H PrintedrTyped Name Signature Month Day Year <br /> O <br /> a <br /> Z 34, Transporter Acknowled ment of Receipt of Materials <br /> PrintedrTypsd Name Signature Month Day Year <br /> f- t` <br /> 35. Discrepancy <br /> 46. <br /> SEP I <br /> i` <br /> 6. <br /> r 36, Ha rdwj4 Waste Report Management Method Codes (.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> ?^ <br /> ILE *6700r22A (Rev. MS) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br /> IL <br />