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IN CASE OF EMERGENCY CONTACT: <br />;sand Telephone Number121 <br />STANDARD MANIFEST 001 -10 -06 -STD <br />a Pit 9as 3: <br />- -- GENERATOR'S REGISTRATION # <br />2B. CONTAINER TYPE 2C. NO, OF 2D. VOLUME <br />f:.. :ass w CONTAINERS <br />Cu Ft. <br />�M. <br />Cu Ft. <br />- 9 <br />Cu Ft. <br />Cu Ft. <br />Cu Ft. <br />Cu Ft. <br />_ e Cu Ft. <br />r <br />by declare that the contents of this consignment are fully and accurately TOTALS P • ' Cu Ft. <br />ng name, and are classified, packaged, marked and labelled/placarded, and <br />for transport according to applicable international and national governmental regulations:' <br />Signature ` Date <br />Phone <br />Applicable Permit Numbers: <br />m <br />ar a <br />ON: Receipt Of medical waste as described above.' <br />g ature Date <br />ISPORTER 2 ADDRESS: Phone #: <br />Applicable Permit Numbers: <br />3ANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br />Signature <br />ISPORTER 3 ADDRESS: <br />$ANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br />Signature <br />Facility: <br />8C. Alternate Facility: <br />Date <br />Phone #: <br />Applicable Permit Numbers: <br />Date <br />8D. Alternate Facility: <br />Ized by the applicable state agency to accept untreated medical wastes and that I have <br />I the requirement outlined in that authorization. <br />—Signature Date <br />LEAVE AT rG E IERATOR <br />