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Please print or type. Form designed for use on elite 2-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) CALOOU IZM OOM1471SKS <br /> 24,Generator's Name <br /> `Gc crown R Tun= rFKrn=P=n SAM F <br /> 25. Transporter Company Name U.S.EPA ID Number <br /> R_FnRQQK INC: nRA TSMT CO i MC)nn smR. qR <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 /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> s <br /> O <br /> Q <br /> WTWOz <br /> W <br /> t� <br /> i <br /> f <br /> I <br /> 32.Special Handling Instructions and Additional Information <br /> ix 33.Transporter_ Acknowledgment of Receipt of Materials <br /> LLJ Printed Typed Name Signature Month Day Year <br /> a , o t 281 1 <br /> Z 34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name ure Month Day Year <br /> F— <br /> r 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> 0 <br /> W <br /> Q 36 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> C7 <br /> rn <br /> W <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />