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Iq it <br /> NON-HAZARDOUS I'-Gane"no"D Nur"ba' 2.Pageld 3.Emergency Response Phone 9.WasleTrdckingNumber -29b <br /> WASTE MANIFEST 211) <br /> 5,Generators Nam ancl Maikng Afktm Geoemo?s Sle Address(ff diferept than maing address) <br /> Geneia[Y5 Phone <br /> (I.Imnworter 1 Company Nam U.S.EPA ID Nwbw <br /> 7.T=Wor2GortpsnyName U.S.EFA ID Number <br /> S.Da"tadfa"V�m and Me Adds U.S.EPA ID Number <br /> FadliVs Phe: <br /> 9a. 9b.U.S.DOT DevAplion(MWM Proper ShOphg Name) to.con mrs II.Total 12.Unft <br /> He. Type OwnUty MAU. <br /> No, <br /> z 2. <br /> 0 <br /> 3. <br /> 4. <br /> 13.Special HaK*V Instructiore,and Addihonal Information <br /> 14.GFNERAMR'SCEAYIFICATtON;Icandy the maled&dmnbodabove wItis m IrAomr"siblOtok,demife"Umlorrepro Wgpmper&posalofHazardwsWaste. <br /> Genermr"lqs.PjptaFypedNnm j svffitaro Mwh Dw Year <br /> 15.Inlernallonall Shipments ❑Import to U.S. ❑aport from U.S. P60.1 eritry/mt: <br /> Iransponer Sigianve(tor opens"): Date leaving U.S.:- <br /> 16.Transporter Acknowledgement of Recelpt of Materials <br /> TmnsMter I PrOWyped Nam Sotature o MDnlh Day. Year <br /> 0 <br /> Z Transporter 2 PrWWV*Nam Sodure <br /> Mwlh Day liar <br /> 17.Disvepanq <br /> We fhswepecy Indcation Space ❑owntay 11 Type 11 pa" ElPartial Rejection ❑Ful Rejection <br /> 5i j <br /> I76.Alternate Facky(or Generator) Manifest Refenonm Number. U.S.EPA ID Nurnber <br /> LL F Phone: <br /> 17c fkqn.twe.l Ml.,,d.Facility G,mrato MMflh Day Year <br /> UP <br /> O <br /> 18.Designated Fadhtv,Omer or Operator.Gerfiacation o(reoeqn of materials covered by the MankM DOW as Need in Item 178 <br /> Pnnto&TMW Nam <br /> 169-BLC-0 5 11977(Rev.9/09) TRANSPORTER#2 <br />