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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 o1 3.Emergency Response Phone4.Manifest Tracking Number ^ C WASTE MANIFEST SAI 13131i1i'(S7 •'° , A _! ;� X• G Br 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) MOP Nv O 3 4511 PAUPIC,AVE. Generator's Phona,',4a_f ; 6.Transporter 1 Company Name U.S.EPA ID Number tWEWAN VALLEY W iQ-CII..IIS 7.Transporter 2 Company Name. U.S.EPA ID Number alb°I•�ICYC0 �' =.Ciltsi.i'f'�tifdgwi t, {1'tJ;!( dF�. li°i.: a(9f]C7iI �i 8.Designated Facility Name and Site Address U.S.EPA ID Number ;I2;I i.Y:NIUY MARICAli 1441 A1_)Af mI IN},,vA51P.,.t 6.(, Facility's Phone,, >> - _ ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)} No. Type Quantity Wt.Nol. +Y 1 ? �dd5��4" y�t«ai Z2. t: fv air.I`IfV fXA�: WA5i.E !Xj;