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Form :iroved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST Paye 21 Maviffetit Tracking Number <br /> (Continuation Sheet) <br /> 24,Generators Name <br /> A J 5,EPA ID Number <br /> 25, Transporter Company Name S A <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 /> Hits and Parking Group(it any)) No. 1w Quantity WLArol. <br /> LU <br /> 32.SpecR HarfAM ln-,trjr,ions slid AddRkx4 In"T00 <br /> 33,frallupodw- Acl, 6t trtmt€of RfujA.of NIAlf-r i',fls <br /> Printodrryped Nana? Month Day Ywx <br /> 0 <br /> CL <br /> cr, 34.Tr eipt of <br /> tRspwW___Name Signature wnil) nay Year <br /> 3A,fJ6sexety <br /> 3, -iazar&us Wa*Report Management Method Codes(w,,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W <br /> ERA Form 8700-22A(Rev.3-05) Previous editions are obsolete, DESIGNATED FACUTY TO DESTINATION STATE(IF REQUIRED) <br />