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Pieria an or e, form des reed for use on a ite 2- i <br /> leh writan) <br /> a, <br /> UNIFORM HAZARDOUS WASTE°MANIFEST 21.Generator I0 Number 22:Page 23.Manitost Tracklug Number FormA,pproyed;OMB No.2050.0039 <br /> (continuation Sheet) I � �, , f �� — <br /> 24.Generator's Name <br /> �at^�,Jk ':4 C # til <br /> VL <br /> �_ <br /> 25. TransporterCom an N <br /> p y ama U.S.EPA ID Numbor <br /> 20. Transporter GompanyNama U,S.EPAIbaar <br /> 27a, 27b.-U.S.DOT Doscriplion(including Proper$i no Name,Hazard.Class,l0 Numher, <br /> HIM and Packing Group(it any)) 28.Containers 28,Total 30.Unit <br /> No, Type Quantity WtNdi. 31 Waste Codes ! <br /> 1 <br /> r i <br /> u.r <br /> FI I <br /> I <br /> i <br /> 32.5pocl I Handling jnalructions aid Additional lntormaion <br /> 33 Trens <br /> crier.• <br /> �� Ac+tiio I <br /> w e meri <br /> � d f o(Recel t of Malerl Is: <br /> ti Pdnledrmy ad Name <br /> - Slpriaiuro <br /> Year <br /> i i Yl^� F Monitt Oay <br /> 34.Trans Drier Acknowled mast o(Recar t of Materia' ' <br /> >C PrinledfTypad lame <br /> Signature <br /> i May ear <br /> 35.Discrepancy , <br /> i <br /> v <br /> LU,q <br /> 3fi Hazaritous Waste,RepP�laeager�ienlMelhod GSda:U�r.�dl3.sferhaz�r�tDus:yya�fkt(e,�Urlenl,;i�sRosBi,.�A�ies}yga.4@;slCS4stns7, <br /> n <br /> EPA Form 11700-22A(Rev,3.05) previous editions are gbso ate, I <br /> DESIGNATED FACILITY TO GENERATOR <br />