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• �C. �Q5 64. 0409 <br /> Please pent or type.(Form designed for use on elite(12-pitch)typewriter.) Form proved.OMB No.205MO39 <br /> UNIFORM HAZARDOUS 1.GenemmrlDNumber 2.Page/of 3.Emergency Response Phone 4.Manifest Thatg Number <br /> WASTE MANIFEST... C0440O 1172.... . . . , . .: . i .. . 916-3115747, 003915048 <br /> JJ K <br /> I <br /> "W <br /> m a MAW <br /> 's Generator's SimAddress(if different than mailing address) <br /> 11530 W EIGHT MILE ROAD. <br /> STOCKTON,CA 93119 <br /> Generators Phoney 24431011 <br /> 5.Transporter 1 Company Name• U.S.EPA ID Number <br /> cR MOSENIVRONMENTALSERWCE9.;Ui,..�.. ........-..... CADD1400310 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> e.De ENT(l U.S.EPA ID Number <br /> . _. 3=1 OLD SKYLWE,ROAD... <br /> CA <br /> IUOD56117 <br /> KETTLE M CRY.CA 93939, <br /> 806222-2964; <br />