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Please print or type.(Form designed for use on elite 12-pitch)typewriter) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST C ,G,-P 1T 0 0 2 5 3 5 7 'i 1 t<(Fti-=:511)"ate{)'1'9ff 014378811 J J K <br /> 5.Genentoys Name and Mailing Address Rb MEOW Generatofs Site Address If different Than mailing address) <br /> 15Ps E f'&.:SCAMRCI 0 <br /> RACY XALN 204 <br /> Generatofs Phone: <. 1 9 891-1 - 1506 <br /> Fit— <br /> B.Tran a der l Company Nam U.S.EPAID Number <br /> nn�y;•(„ER337t1 or1N.w;,3Tcj- ?1711�ECy if+- G, fry (t n ,1 9 :r 1 f :9 <br /> 7.Transporter 2 Company Name FEB 0b U.S.EPA ID Number <br /> 8.Designated Facility Name and Site AddressNTq�FIEALTFi rip 4, U.S.EPA ID Number <br /> kAlOsb4,Overton,Overton,Inc. PERMIUSER <br /> 11; <br />