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Please print or type. <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1 Generator ID Number <br />pki <br />5 Generator's Name ani Maffing Address <br />• <br /> <br />Generator's Phone - <br />I war <br />6 Transporter 1 Company Name <br />P AMC.' FilliftP:ONMEITr <br />7 Transporter z Comparvy. Name <br />8. Designated Facility Name and Site Addressp.41.10s emi.walm4i <br />1515 OLfl1 f Fvt-F <br />S.ACPA 44E141 <br />:06-371-5747 Factitty's Phone- <br />9a .9b U S DOT Description (including Proper Shipping Name, Nazar <br />HM <br /> and Paciwig Group (if any)) <br />NLH F- CFA ;-1, I.APOOLIS, V1'4k;:27E LIC-aesID