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Please print or type. Foan Approved.OMB No.2050-W39 <br /> UNIFORM HAZARDOUS WASTE MANIFEST I 23. i z2. 2t [I <br /> 1cmdnuatlon Sheol} <br /> 24.Cimralor s Nave <br /> e <br /> 25.Trar�spater C9rrpary Name Q A i /' 0$ t t�PI-T i1.5.EPA 7�rtber <br /> U.S.EFA IDNWW <br /> 26.Tt9nsww Cornparry Nam 1 <br /> 279, 27b.U.S.DOT Daoxippm(mckdrm Prater ShOpkq Naps,Harsrd CIE",ID t*04w, 28.coniTypo 29.TOW 39,U" 31,Waste Codes <br /> HM arn1 Pedcieg GfCUp IdY)i Ifo. CwntlCy Wt.NM. <br /> K <br /> 4 <br /> W <br /> 2 <br /> W <br /> I <br /> 32..Sp=W HwOV Instr 4msandAdditoW Informton <br /> a 33.T t ot RecwN ofM rois <br /> Pnntnuryped Nave s pn9a a Moth Day rear <br /> L a� 1 Ku�t�u� I ! <br /> i 34.TwmofRmi dM1 s <br /> Printed Typed Sigtlah7te Monrh Day Year <br /> 35 r�W <br /> J <br /> U <br /> U., <br /> Q36.HaMrdous Waste ReW Mw*gernerd WttW Codes Ii.e.,miles for t�azmdous vaste ueatrrren4 disposal and roeyckg system) <br /> 2 <br /> r7s <br /> w <br /> O <br /> EPA Form 87W22A(Rev.12-17)Previous editions are obsolete. DESIGNATED FAC}LITYTO EPA's e-MANIFEST SYSTEM <br />