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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST <br /> SKS <br /> 5.?"rator's Name and Maili Address SHOIGenerator's Site Address(if different than mailing address) <br /> 14;15 `•vAf.;' ,r:iiit'� :,!' <br /> s".,CAL ON CA `35320 <br /> '"�••i, 'y ��i��t `t <br /> Generators Phone: <br /> 6.Transporter 1 Company Name t.r� U.S.EPA ID Number I,v <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address ;At r-'T't--K L�K N :: <br />