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Please print or type.(Form designed for use on elit 12 itch typewriter.) * 115( P )h'P ) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Nu Ter 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST -,, f_ - <br /> , .�, d1 00�88�738 JJK <br /> e(K) <br /> 5.Generator's Name and Mailing Address 1 Generator's Site Address(if different than mailing address) <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> -1 kl -":AJVV POAE!04 -HL- ki/ffi 41'ft: If >44ht~i 5 t U _s t (t <br /> 7.Transporter!2 Company Name 11 i P `r S 1) / INCU.S.® EPA ID Number Pf <br /> (.,I-L.:�iAa �-I N'--€ , ,`'1 E t4VIR NI l i AL SERVICES' NC M F D li <br />