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02/19/04 10:02 FAX 11005 <br /> PLUIShad by J.J.KEufR 6 ASSOCIATES,INC.,Neenen,WI•USA•(800)327.6866-Printed In the United Stat-:s <br /> r <br /> EMERGENCY CONTACT TELEPHONE NUMBER <br /> UNIFORM HAZARDOUS 27.Generator'sPUS EPA ID No_ Manifest 22 Pag IrrformatlonL ithe shaded areas isnot <br /> WASTE MANIFEST Do <br /> ` squired by 'Federal law' <br /> (Continuation Sheet) , <br /> 23.Generator's Name . 5 ffe d Docum N <br /> /l/ r <br /> 46. a.n;so <br /> rter y N.Stale Transporters ID <br /> O.Transp°rtee, Phe <br /> r Company Name 27. EPA ID Number P.State Transp;nrtera f <br /> Q.TranspoReez:Phone <br /> 29.Containers . 31. <br /> 28.USDOTDeacriotion(/ndudurProaerSh'yPcrg IJ� e,( zrd Clara,,,end/DNumbQ <br /> iT,r�l unit R. <br /> HM No Type Quantity WtNol Waste No. <br /> EL <br /> b. <br /> C <br /> p d <br /> E <br /> N <br /> E <br /> R <br /> A e. <br /> T <br /> O <br /> R <br /> f_ <br /> h. <br /> S.Additional Descriptlorts for Materlats Listed Above T_Handling God3s for Wastes Lh3ted Above <br /> 32.Special Handling Instructions and Additional Information <br /> R 38.Transporter Acknowledgement of Fiecelpt of Materials Date <br /> fAPrintedRyp ams <br /> 4 Slg°awre Month Day Year <br /> S <br /> P <br /> R34.Transporter Acknowledgement of Receipt of Materials Date <br /> T Prinlsdrryped Name Signature Month Day Year <br /> R <br /> A 36.Discrepancy Indication Space <br /> C <br /> L <br /> I <br />