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Pleaserintort <br /> p yam• Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST isL�:y.--I: ,,c I, I: -J: 013120751 FLE <br /> 5.Generator• ame and Mailing Address Generator's Site Address(f different than mailing address) <br /> -c-, <br /> GeaeraWS Phone' C -`4'' :..r ' <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address _ U.S.EPA ID Numberµ'- <br /> Fadlity's Phone,. ='t' y,= - •+ .c,�'a 4 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> IHM and Packing Group(if any)) No. Type Quantity 12.Un 13.Waste Codes <br /> 0 +4Gi! r�k_•:<i-1 E�..i.cz r'lJL•J� F+^.:}.� .. :J i�� L.!7'y':altif?6Y 1 �ti�i+a� - •, <br /> LU Rt'- "UCitt':+ W._{:a C •?. i.,l�: '�•cs it siA 111 ' l's'i <br />