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- .. <br /> • 1.Generator's US EPA ID No. 2.Page 1 3.Document Number <br /> of <br /> NH- ' N° 4319 <br /> 2 <br /> ' 4.Generator's Name and M 19 Address ,. <br /> 7 o a Wt27- 19Z� <br /> Generatces PhoneSr -2 <br /> _? 5.Transporter Company Name s 6. US EPA ID Number T.Transporter Phone <br /> S.Desl na�ality S Address 9, U EPA 7NUJT?;,�� 10.Facility's Phone <br /> 1 1 <br /> 36 <br /> Ghl <br /> W 11.Waste Shipping Name and Description 12.Containers 13. 14, <br /> E Total <br /> QuantityUnit <br /> l <br /> R: eCTJ7 r: vrz 1 fit✓ l�� <br /> b. <br /> 15.Special Handling Instru 'ons an Additia Intormatio Handling Codes for Wastes Listed Above� n <br /> 11a. 11b. <br /> Printed/Typed Name Signature <br /> T" <br /> Ry Year <br /> A � � 3 <br /> s �STTiai>spor�et` _ .. <br /> 0 PPrintedrryped Name Signature <br /> R <br /> R -�/t-/ r �- ► 4vt� <br /> / Day r <br /> 17Z <br /> 18.Discrepancy Indication Space <br /> F ` •I!" ' <br /> C <br /> L <br /> 4�u i4 JLJ <br /> PrintedlTyped Name Signature <br /> t' Month Day Year <br /> WHITE—ORIGINAL(Return to Generator) LLOW—TSOF(Retain Copy) PINK—TRANSPORTER OP GOLDENROD—GENERA ORS COPY <br />