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Please print or type. Form designed for use on elite(12-pitch)t ewriter. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22 Pae 23.Manifest Tracking Number <br /> (Continuation Sheet) CALOW376" 00IM SISKS <br /> 24.Generator's Name <br /> Re TALI of IRRGR rn itur AAUF <br /> U.S.EPA ID Number <br /> 25. Transporter Company Name RFn, OC.K W. DFA TSMT Q <br /> _ _ � Oa095038998 <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29,Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Vol. <br /> i <br /> i <br /> O <br /> Q <br /> W <br /> WOOz <br /> W ! <br /> 0 <br /> i <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> LLJ PrintedfTyped Name Signature Month Day Year <br /> 0 JEFF LEAVITE —� 1 91 281 18 <br /> Z34.Transporter _ Acknowledgment of Receipt of Materials <br /> Printed/Typed Name gnat Month Day Year <br /> H <br /> r 35.Discrepancy <br /> t— <br /> J <br /> U <br /> Q <br /> LL <br /> LU <br /> W <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> c� <br /> ti <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />