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APP:Grisice 1.070T19.2 Fo.-MApproved.OMS No.2050-0039 <br /> Please print or type.(Form designed for use on ete(12 itch)typewMer.) 22 Pa .= 23.Manifest Tracking Number <br /> UNIFORM HAZAROOUS WASTE MANIFEST 21.Generator ID Number 9e <br /> (Continuation Sheet) <br /> 24.C-enerators Name <br /> Tzrapt gtTrn T-t1&'; <br /> p,T T NI: 0everSe LQgl5t;C5 1-'rCCe553� <br /> U.S.EPA ID Number <br /> 25.Transporter Company Nems <br /> U.S.EPA ID Number <br /> 25.Transporter Company Name <br /> MN <br /> 29.Total 30.Un 31,Waste Codes <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Nama,Hazard Class,ID Number, Quantity WL/Vol. <br /> HM and Packing G!vup(d any)) <br /> °rds�sTr CCF'r OSIVP 1_10;'I1� 9ASIC WORG1ttiIC <br /> (� . lJV'J.t !JJ <br /> A, n !i/,!t,,11 All 5 n 1 0.1^1^.6'3 n 1 011,-J.,(nr-f'.TICN1 j,L�,L!Y•75.LV,r'V !Sj?nN RC=RA HA7ARf1QIjS,tAJASTF I_IQUIDS(017 jFI\IT, 943 <br /> ^ C :. c <br /> :wrtirj,�irri,iv vi4c,iJ v+vc <br /> o: <br /> O <br /> w <br /> z <br /> w <br /> O <br /> 3SS1111 p11 11 ec�l�ddllingInnucuonsandAdditionalInformation <br /> LP 1 x 5 D F <br /> S. LC_0RN LP 1x:70;JP <br /> 33 Trans Re Ada!owknent ad rof Receipt of Materials Month Day Year <br /> �tl Printed(ryped Name <br /> Signature <br /> O <br /> a- <br /> w 34.Trans rter Aknowled ment of Rete!'of Materials S gnature Month Day Year <br /> Pnntedfryped Name <br /> r <br /> 35.Discrepancy <br /> J_ <br /> V <br /> a <br /> LL <br /> Q36.Hazardous'dJaste Report Management Method Cees(I.e.,cedes nor hazardous waste treatment,disposal,and recycling systems) <br /> z i I <br /> s� <br /> w <br /> EP�Form4700-22l��Rev.3-05t Previous editions are obsoleta. _ r�EB!�E'�� bb�ED FACILiT"d TO DESTINATION STATE(IF REQUIRED) <br /> G ear z Dors s Tie a Droer!ate oerrnitF tar an»u::;:ace_o;tie xa-te tr.e ca.-,e <br />