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02/19/04 10:00 FAX Q003 <br /> EMERGENCY CONTACT TELEPHONE NUMBER <br /> _ 1 <br /> UNIFORM HAZARDOUS 2i•Generstol's US EPA ID No. Manifest a <br /> reto edify rFede(ahaded areas is not <br /> ument N <br /> WASTE MANIFEST <br /> (Continuation Sh l_Sta He rtnt mb � <br /> 23.Generator's Name <br /> M. late Generators l j <br /> one Co any Nath <br /> 2 WEPA <br /> N,State Transporter's I <br /> 24.TrapVD, <br /> O.Ttanspnrter's Phone ; <br /> Company Namo 27. mber P.State Transporters <br /> TO <br /> 26.Transporlc+ i <br /> Q.Transpcnees Phone <br /> i <br /> 29.Containers 30. 31• R. <br /> Total Unn Waste No, <br /> 28.US DOT Description(induding Proper Shipping Nome.Hszsrc Ci:�s,and ID Numbed No Type Quantity wilvol <br /> HM <br /> l <br /> s. ± <br /> i <br /> l <br /> b. <br /> C. - <br /> i <br /> d. <br /> f <br /> c. I <br /> E. <br /> 9- <br /> h. <br /> i. <br /> S.Additional Descriptions for Materials Llsted Above T.Handling Codes forWaste3 Lrtsd Above <br /> 32.Special Handling irtstruciions and Additional Information <br /> Date <br /> R83.Trans otta AcknMMeti ement of R"eipt of Materials <br /> A Printed/T ed Name @IgtYr111lIw! r`~v Mtihtii Day Ye®r <br /> N " <br /> P 1�411 <br /> 2 �er �C[• <br /> S `•c <br /> P Dale <br /> O 3d•Transporter Acknowledgement of Receipt of Maleriat, Month pay Year <br /> R Prinled/ryped Name Signature <br /> E <br /> R <br /> F 3S.Discrepancy indication Space <br /> A <br /> C <br /> 1 <br /> L <br /> E S <br /> T <br /> Y <br />