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DocuSign Envelope ID:813A5323-29B6-4DDD-A2B8-22B7F4A4A68C <br /> te <br /> Please print or type,(Enna designed for use on elite(42-pitch)typewrIter.) . • Form Approved.OMB No.2050.0439 <br /> 'UNIF fRAAZARDOU5 WASTE MANIFEST <br /> 21.Generator ID Number 22.Page , 23.Manifest Tracking Number <br /> (Continuation Sheet) tyO 96 #` °t <br /> 24.Generator's Name - <br /> • MANGE UMW DEPt OF I(W WAGi 41 <br /> • <br /> . U.S:EPAID Number • <br /> 25.Tmdapnrter•` Company Name . <br /> - 4 US.. EPA ID Number . <br /> 28,Transporter Company Name- .; • ' c i <br /> 28.Containers . 28.Total 3r1.Vatt• • 3t.Waste Cadas , <br /> 21. 27b,U.S.pOTpeaerfpgon{rduding Proper Shipping Name,Hazen Gass,lD Number,- No. Type Quangty WLNo1.• <br /> 'NM and Packerg Group Warty)) —I".. 1 <br /> 0 pE. TKNOE ,,SOW, 1() ,Kin,,, MtlCI PE `s E,a MD <br /> ,.�1� � <br /> F��8), ,9r 1,1104A(k,maim r <br /> t 1ligtt 4 i! _ <br /> 6 PEWEES,LJ ,' X ,O.S.,(SD&C,, .AN $,8,if - _ <br /> • 2 ZILX961 b�� . <br /> Im _. .. <br /> I L P Std' '• - rr-.r ._...:,= • '.y, .; ,fit' 4) :' - _ <br /> iii { . : . .._„.. <br /> O^ ' y NlE 119 WG,a3`k , . r 4 4..-F-3� r {Sx ap✓ ) •. <br /> to,4W-- _ _ <br /> ? - <br /> r <br /> ' <br /> . .. `• <br /> 32,Sprit g9Ji f ,Id IS.ndAdditional Information' . <br /> 1 3-.26.28 3/S'.5 ' • <br /> 7 )AWA5� t1-444EG` S F <br /> f <br /> . .7' • <br /> • 33.Transporter Ac knovdedgmenfef•ReeelptetMaledais M Day . Year• <br /> Pdntedffyped Name ,e- • Signature <br /> . I [ I l <br /> 0) 34.Transporter_ Acknowledgment of Receipt ofWorlds Month Ray Year <br /> -Printed/Typed Name Sigualure • <br /> • I I • I I <br /> _ <br /> ,_ 35.Discrepancy ' • <br /> d <br /> r 36.Hazardous Waste Report Management Method Codes Q:d;;codesfdr hazardous waste Ireatmentfdlspasa l,end reeydlfig'ayslems). - ' <br /> 0 '.,,t4.:k 1 I I,I k't 1 I h°64'I.1 . . I > 1 Lid I <br /> o <br /> 1 t <br /> 1' t ' .- <br /> DESIGNAT D FACILITY TO GENERATOR <br /> EPA Form 8704-22A"(Rev.3-05) Previous editions are obsolete. • <br /> • <br />