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PloaSo print or type. � Form Approved, OMB No, 2050.0039 <br /> UNIFORM HAZARDOUS 1 . Generator k) Number 2. Page 1 of 3 Cmergency Rosponso Phone 4. Ill Tracking Nrnnbet <br /> Iva <br /> WASTE IVIANIFEST y a r} fi <br /> G � ti„ j JJ <br /> T. Generator's Namo and Matting Address Genaralor's Silo Addrass (if different than mailing address) <br /> fit _ f 1 . IJi'I{ l f 'r21),) tit7f` c 7 ?: V ! 1•`. `f:i7:. <br /> 'SLl'1,• it1{; { s,tl''1t. 1:'i rlffi <br /> Generator's Phone: -: . ; — — — -- <br /> 6. Transporter 1 Company Noma V g U,S, EPA 10 Number <br /> tt �11VIlJ r } . rQ'',rli f,'ll'hbi�'N1 fl ; 1 '. 1f +, it!it <br /> _, .._ — . s —r— _�_— _ t—� <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 0. Drslgnated Facility Narno and Site Address U.S. FPA ID Number <br /> tit. <br /> S,U •i +:)Y'a t;trl 'iiR.C11+I1','{%(k -tit '. , .,1L +: <br /> 16 to iC.a, VIIII 1+, IVrc11. t 'il S, <br /> Facility's Phuno:-r ivTl 7 a? <br /> 9a, gb, U.S. DOT Desc ipllon (Including Proper Shipping Namo, l{azaid Closs, ID Number, 10, Containers 11, Total V. Unit 13. Waste Codes <br /> HM and Packing Group (If any)) _ No. Type Quantily W ill <br /> i . f41G1'd 1•ti; <br />