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Appendix B: Sample Manifest <br />Sample varifythis is <br />Manifest your Storo <br />Mdruss & Verify this is your <br />Contact Info Store EPA ID <br />@ CVS/pharmacy <br />Proper <br />Shipping <br />Description <br />Area <br />food be <br />Bled is) <br />Manifest 0 <br />A*. <br />Emergency <br />r, 90G:+ <br />Responso <br />Phone <br />--L— (make certain <br />one is listed) <br />13606flG, 289-'8 <br />Disposal <br />Facility <br />& EPA 10 <br />(make certain <br />awl one is listed) <br />Make <br />certain EPA <br />or State <br />Waste <br />"s are <br />fimd <br />/7966 <br />!1. [w, 5, <br />"W-1 VA <br />j4l3� 24&1 W <br />Transporter <br />wvx <br />Name & EPA 10 <br />Name & <br />(make certain <br />Nz WY L� <br />there is an on" <br />f"424 -72i5 Agwu OA Xvo <br />(to be sinned <br />(Required prior <br />UN19% Y*ft Aww% Pc EfN)on <br />i. <br />An X or <br />—t, <br />indicates tfiere is <br />ON I M Y"a Fo..Om 6 koftw, I"W-- <br />X 4 FgG '78 <br />DOIT HawzwWAws <br />f <br />Material <br />X s,or,, <br />Proper <br />Shipping <br />Description <br />Area <br />food be <br />Bled is) <br />Manifest 0 <br />A*. <br />Emergency <br />r, 90G:+ <br />Responso <br />Phone <br />--L— (make certain <br />one is listed) <br />13606flG, 289-'8 <br />Disposal <br />Facility <br />& EPA 10 <br />(make certain <br />awl one is listed) <br />Make <br />certain EPA <br />or State <br />Waste <br />"s are <br />fimd <br />32 <br />CONFIDENTIAL BUSINESS INFORMATION <br />CVS000010393 <br />Representative <br />Transporter <br />Name & <br />Nam & <br />Signature <br />Signature <br />(to be sinned <br />(Required prior <br />once manifest <br />information <br />to departure <br />from your swel <br />f <br />confirmed) <br />Disposal Facility <br />Name & Signature <br />(included on final <br />copy received <br />approximately 30 days <br />after service) <br />32 <br />CONFIDENTIAL BUSINESS INFORMATION <br />CVS000010393 <br />