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Please print of type.{Farm designed for use on elite(92-pitch)typewriter} Form 1ppr(lve@"ptvfl3 No,2050-0039 <br /> UNIFORM RAIARDOUS WASTE MANIFEST 21.Generator 10 Number 22.Pager; 21"Manifest Tracking NuTP l;, <br /> {ContinuatfonShect) CAL.0t 03910t'3 of l�!]t�I.t�37£)i�I}Id"1' <br /> 24,rselrvators Name <br /> BIG LOTS STORES <br /> 300 PHILLIP RD RTTN: D£NR EERM COLUMBUS OP. 43229 (614)210-4614 <br /> 25. Transporler_- CompanyNsme U.S.EPA ID Number <br /> n6 Trensporler Company Name U.S.EPA ID Number <br /> 27a" 27b.U.S.DDT Desefiption lijLwing Proper Shipping Name,Hazard ctass,IU Number, 23,CorrWners 29.Tntai 30.Un t <br /> HM andPackirgGroup(r7any)} 3t.WastecWvs <br /> No- Type Quantity Wf.NoI. <br /> ^�} <br /> tP <br /> r c <br /> Pill 11 <br /> P�Q➢EfC.iS1 � ��•�_ <br /> ( 331 <br /> r � <br /> I HYDROGENtl � <br /> RB*HE, 1-7 <br /> 9 UN2018 WASTE TOXIC, LIQUIDS, ORGANIC, N.Q.S. (2,4-D) fi.1 P61I � 3, <br /> .. LL <br /> Z <br /> 11 NOH-Mll I# MRIOUS WASTE"LIQUID (DETERGENTS) 5IiI <br /> P <br /> a <br /> 13 <br /> 14 <br /> 32"SPeciat Hartdfing lnstnrctforrs andAdddional infonnakon JS) OLNONREGL 1 BLNOHRE6SOL 03 - BETHG-(71 <br /> ILPE ME (H) £ (9) BLTOM-03 - ER61153) TOXIC ILIQUIDS LOOSEP (10) <br /> fflEffiR6. (11) VMDETRGNTLIO-04 - LIQUID LAUNDRY DETER (I i-%EftCH <br /> � 33.TranSpOdr'r__AlyrnawlCdgmen!of Recei of Ma3ertae <br /> Pri WITyped Name Signature Marith Day Year <br /> 4 <br /> a- <br /> i S4.transpo ter Adrnowladgmatt of Reye pt of h lsater als <br /> PriRSedffypedNarne Signature Month Pay Year <br /> h <br /> 35.cisrmepaney <br /> U <br /> w <br /> r� <br /> 36,Hazardous Waste Repoli Management Method Codes(i.e.,codes for hazardous waste treatment,disposal.and recyding systems) <br /> tJ} <br /> 12) <br /> EPA Farm BIW-22A(Rev.3-95) Previous ediliiam are obsoiete. DESIGNATED FACILITY TO DESTINATION STATE(Ir REOUIRED) <br />