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Please^ nt or e. Form desi ned for use cn elite 12- itch <br /> I UNIFORM W RoOUS WASTE, - � ewritem <br /> r1r1`��Pe3 _1.Gererar ID Number <br /> I fCOn>!ittiia4lnn Q;`....s � o-,.� <br /> - -'` 4.mannest Tracking Number vi'vio Z),2050-0039 <br /> 24.Generators Ptame ��. <br /> Tanw store T-1526 <br /> - <br /> 25. Transporter Company Name <br /> U.S.EPA ID Number <br /> 26. Transporter Company Name <br /> U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including p <br /> HM and Packing Group(fan � aper Shipping Name,Hazard Class,ID Number, <br /> Y)) 28.Containers <br /> RQ UN3366 W 29.Total 30.Unit <br /> IN AHI N-a S A$TE()ORl�O�ryryg LIOIII +r No Type Cuantity Nt.Not. 31.Nlasta Codes <br /> HIPOCK0 $',PG 01UM HYOROXI E SWIM <br /> fl=03) 001 OF 00130 p 322 0092 <br /> p/R�GANif, <br /> OL�5y�O RROSptIYEpLl4�U�IyD AOl01C/3� <br /> ✓�0� �Y�� -7 rd4/�llli L01�rIs�6P0b0 V <br /> 001 OF 000= 791 0003 <br /> x 7:UN"72:WAM AMMONIA SOLLM9IS,gr pg III <br /> 4 41 O 00430 p 141 0003 <br /> ��IMONE.N0N�� <br /> 94 (OETEMENN�,l+l/ALU <br /> �l S . LIQUIDS. <br /> 00 OF 00130 P 38 <br /> 3 <br /> d <br /> a — <br /> X <br /> 32.Special Handling InsUuctions andAddmonal Information <br /> 5•CP329969 ERG1154 1X30 <br /> 6'LCt,RC ERG1153 1X5 <br /> 7.1&-R EPGA1154 1X5 <br /> 8-CH329962 5 <br /> r 33.Trans orter Acknowled mertt of Rece t of Mater als <br /> U Printed/Typed Name <br /> Y Signature <br /> D <br /> Month Day Year <br /> 34.Trans orter Acknowledgment of Receipt of Materials <br /> t Printed/Typed Name <br /> Sign <br /> onth ay Year <br /> 35.Discrepancy <br /> I <br /> I <br /> l <br /> 1 <br /> 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyCing systems) <br /> i <br /> MIGNATD FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> Form 70 "22A(Rev.41.1) Previous�d�t�ons are t1 s ete. generator A snipping <br /> �__.,i�,�,1,�ia.raautOfODriBEA perrn�s and gill accept the wade�� <br />