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_ M D <br /> ri m <br /> C) NONHAZARDOUS 1,2rdtor IH Number cn <br /> W WASTE MANIFEST eey�ea �5 Q 2 Page l� 9.Emergency Respofw phone- 4.Womw Traddng Number O (n <br /> �'AL-opo 1 I R Y , <br /> CD 5.Ganeralofs No and Maii�g Address r �; .� - I N <br /> f c a Z 6 !i! r Ta�1/ L Generarors srte address{f ddferBnr d an ma ng address)' oo <br /> JY�4_yl�iN j <br /> c r"c h .,� r.4gE 7. O m <br /> cn � c y 9��a 3 <br /> NGBnemtor9 Phone—/ 3 $! _76J (Sl <br /> m :1) 6.Transporter 1 Comwy Name I <br /> N <br /> = U.S.EPA b Number O <br /> cn 7-Tranaportor2 Company tJamrj CA r=G' J7fF='a—.;P73 <br /> C/� U.S.EPa IG Nrymlber <br /> 8.Ge&gna7yBd FagXty Nay-me�and Srte Address TR /C�� �� cn <br /> U.S.EPA M Number z <br /> rJ � ���1❑ 77��f,s .��rr�S� zy <br /> Fac r Phone: O <br /> 3.Waste Shipp"Name and <br /> (p �esCrgElam 10.Contemners <br /> 11.Total 12-i X (� <br /> No. Type Quantiry WlNd. <br /> a <br /> z. <br /> p o <br /> 0 3. <br /> CD 4. <br /> e--r <br /> e--r <br /> O 13.Special Handrlrrg Instructions a»d Add'dpna!lnfornloon <br /> 14.GEMRATDA'SIDFaiii in RF1CTGN: rclre <br /> mal lie contents of Ws n <br /> end awurp <br /> Gonmera and f�I"+marded.and"i7 all respells M proper Wrd bon for transport a 1B brre®inEernadpndl arq dw- �B by�P'o"r 3I�tlng�b•�are classified,pa <br /> f�DflBrofs PnnledTyped Name',. gmvemmenl%el regi daUpng. <br /> 1 Q-A—um-11, - Month Day Year <br /> T5.ln*alafional Shlpn-..- . <br /> import w u-S. ❑Export rrom U.S. ' <br /> x Tran er S- lure ore rm Part of.erWylexil; <br /> w 16.TransParlor Acknowfedrynerduf Aecerpt of Marla, Dale iaar' U.S--: <br /> Transporter T PrinIa yped Name. . <br /> ❑ Signature <br /> hfontlr Day Year <br /> a Transporler2 PrinWyped Name . <br /> r *nature . <br /> Momh Day Year <br /> T7.DisCrepynty <br /> 17a.I7lscreparwy irldMzlion Space <br /> ❑Ouanlity ❑Type ❑Residue ❑Parua Fiejetdon ❑FWl Relaction <br /> r 17b.Altemale Fwky(or Gerreralor) McMest ABIereOCe Nutmeat; <br /> '"r U.5.EPA 1p Number <br /> YFaciliry's Phoha_ <br /> 1%.Signature of AllafnetB Facility[or Generator} <br /> a <br /> � Month Day roar <br /> ;0 <br /> S.Lyes+gnatee Facaity Owner or pperaror.Cerri6cation d recap[m maleneLs wvered by he nVlniQBe[erscapf as nofee m Ilam 17a O n <br /> Annte&T ped Name <br /> Smgnatwo O <br /> M M Day rear a Q <br /> 789-13LC-05 11977(Re 9M) � <br /> GENERATOR MIHIPPER'S INITIAL COPY � -0 <br /> O <br /> Cn <br /> ED <br /> (Q N <br /> (D <br /> O <br /> W <br /> O <br /> N <br />