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NO <br /> N:HAZ:RDOU$ <br /> : <br /> :] G!!.a <br /> t! D NUaft, <br /> PP 103.Emergency RMOMr Phone 4.1asteTraking Numbe <br /> WASTE MANIFEST r � <br /> 215329 <br /> ,.: aalaNamW"W,Adaeee �mmmsSite Adores <br /> (a ovieseef Than moliftgaddress) <br /> Tim d. <br /> CieaysWs Phone <br /> 6.Tmnsporter I Comanq,Nam U.S.EPA ID Number <br /> 7.Trans"2 Coma"Nam U.S.EPA ID Number <br /> B.D8" <br /> U.S.ERA IDNumbs <br /> Faclil Is Phone: <br /> ga. 9b.U.S.DOT DesuVion(imkxkT ProperShopfaff Nam) tO.Comairters II.TDIal 12.Unk <br /> No. Type DUMMY MAM. <br /> 1. <br /> w <br /> z 2. <br /> w <br /> 3. <br /> 4. <br /> 13.Special Hamft Insuictions and Additional Infoanation <br /> 1W dj: 71L^-1.3-1 <br /> 14.GENERATOR'S CERTIFICATION:I Ce"the materials desoribecl above on this manifest are not subject 10 federal fegulatoos for reporting Proper disposal of Hmrdws wado- <br /> Ge-lp,'Vk <br /> Month <br /> 15.1010MUDMIl Shiments El few 0 U.S. Exporl from U.S. Pad of entlyleot: <br /> Transporter Salm(W experts ora# Date leaving U.S.: <br /> CC 16.Transporter kkwNWWmjt o(Receipt of Maledals <br /> TrarWIff I PArraffyped Nam signeure Month Day Year e <br /> MI <br /> 0 <br /> he <br /> z <br /> Transporter 2 Prk"Wryped Name Signature Monal <br /> 17,Discrepancy <br /> 17.Disoamocy Irdudica Space ❑OuarrUty El Type El Raw, El Partial FtejwW ElFul Rejection <br /> Manifest Reference Number: <br /> M.Allemale Facility for Generator) U.S.EPA 0)Numbor I <br /> FacORYS Phone: <br /> 17c.ftwome of Afterrate Facility for Gauxator) Meath Day Ntar <br /> Mj13 <br /> 18.Designated Fanky Oarrer or C"mw:Caalilication of racelpt of mat6iiads covered 4y ft man lest e=W as wed in Item 170 <br /> P,Wedrryped New Signature Mqnffi Day Year <br /> N <br /> 169-BLC-O 5 11977(Rev.9/09) TRANSPORTER#2 <br />