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Please print or type.(Farm designed for use on eine(12.010)typewriter.) Form Approved,OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.G'neraw ID Number 2,Page 1 of 3.Emergency Respnnsa Phahe 4.Mantfett Trachin Number <br /> WASTE MANIFEST CAL�9�'0��5�17�7 1 415.923.6772 f FL <br /> 5,Generate s Name a d Gla u g AddressUeftratcM SO Address(4 d1forent than rnagag Mass) <br /> t #xrt,iris «tl`rte v'Y€x1,7 1'g stn Vh',1 t$tn, f.l'monen <br /> 3200 i,El f">Ot sdf,7 St, <br /> "AG'0:1cm,Cox. M, <br /> Generatoes Phone, �hv-qvl- ms=s <br /> rarstwter 1 pang Name U.S.EPA i0 Number <br /> urio'1 Ptvfic i <br />