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1 <br /> Pleaseprint or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> 1.Generator ID Number [I.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS ��p'-.` , �� JJ K <br /> WASTE MANIFEST :, c, ;i r�r:•-r r - <br /> 5.Generator's Name and Mailing Address Generator'§Slt A$dieS's-if different than mailing'address) <br /> STOC1ITON, ;TEE(, <br /> 3W3 F.(-IAItis"1rEh;.f.lkNF <br /> P.O.Rr�''CjX RAN <br /> GeneretbrS Pho lV rjt' CAA 9',M 4,T( e;KTON (..,A M2112 <br /> 6.Transporter 1 Company Name C Ja,nt? 1. U.S.EPA ID Number <br /> 7.T n�spQbffer/2'C irNp y Name' n / U.S.' 1D umber ( - <br /> f l.14�. {q ! ] �t,jr ` �s - C g ��l�d��l�: <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CROSBY&C: <br />