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y <br /> Please'print or type.(Form designed for,use on elite(12-pitch)typewriter.), Form Approved.OMe;'No �O 0039 <br /> UNIFORM HAZARDOUS 1.Genera ohiD Number 2.Page 1 of 1,3.Emergency Response Phone 4,Manifest Tracking Number <br /> Ap r, �. <br /> WASTE MANIFEST "` K` � � u�$;$� G:°�- rr.� �SIM 8 '� �` 0 � <br /> 5,Generators Name and Mailing Address Gener'ato s Site'Address(if different than mailing address) <br /> 'Generatos*Phone:' -t`'f 0 ' ;r'. 1J: <br /> 8 Transporter 1 Company Name U S EPAID Number <br /> met"', vth�m,).Arot�;'tlt`.. <br /> 7.Transporter2 Company Name U.S.EPA ID Number <br /> 8.De�SlgOateda�e�LtyI�eeia�pd;SiterAdd(ess);yt, U3.EPA ID Number <br /> Facility's Phone"' <br /> 98. 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, lb.,Containers , 11.Total 12.Unit 13:Waste Codes <br /> HM and Packing Group(if any)) No. Type, Quantity Wt,Noi.,, <br /> 'r`, 1 t�t'i14t'Sv"�Rr:`# �r`"�Aff 04°t'�;ntsf,�: <br />