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Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21•Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) ' D'� `� 41.�, J Z I', <br /> 24.Generator's Name 6 <br /> --�# k � L <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> z c /'Y'L-� <br /> 26 Transporter Company Name U.S.EPA ID Number <br /> I <br /> 27a. 27b.U.5:DOT Desuiplion(inOu ft proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Parking f*Wp(If any)) 31.Waste Codes <br /> No. Type Quantity Wt-Nd. <br /> O <br /> 32.Special Handling Yistn dons and Additional Information <br /> tr 33--T d2L menl of Receipt of Materials <br /> LU 'Pnnted/Typed Name <br /> Signalure Month Day ,m <br /> oq <br /> 34.Transpor�r I of Receipt of Materials <br /> �• Primed Typed Name Signature <br /> Month Day Year <br /> - Report mamag"ent Method Codes(i.e.,codes for hazardous waste treatment,disposal,and tecyding systems) <br /> (ft"-3-M) Previous editions are obsolete, DESIGNATED FACILITYTO'DESTINATION STATE(IF REQUIRED) <br />