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• 'F.�-f 1/�J 1019527 129912 <br /> Please n or Form designed for use on eMe 12 tit evalier, Form Appmved.OMB No.2060-OM <br /> UNIFORM HAZARDOUS 1.Generator 90 Number 2.Pam t M 3.Emergency Ptrone <br /> WASTE MANIFEST CI 7239 2 877 577-2669 0Q5615822 JJ K i <br /> B.GeneraWs Name end MeftAdftu Gerwrator'e SHe Address pf Werant Nit meft s) <br /> Rome Depot C/0 PSC Attn. Rote Depot CS8 MMS BMT 101116 <br /> 5151 Sen 1eIlpe RM DEPOT #1101/16 251 1001mcs Avg <br /> Gene :TH 77156 1866)303-1341 THCA CA 95336 12191825-9139 <br /> e,Transporter 1 company Name U.S,EPA ID NwrAw <br /> 21st CWTURY INPIRONHWAL HROGEHMT W WVAUA, LLC 164012' <br /> . .EP Number <br /> t. Facey N and Site Addrew U.S.EPA ID Nwnber GiY <br /> BDHLI.1GTOR SItQIfl0�1SAL, LLC. 6199T FACILITI< <br /> F $SSP, U 98132 (253} 872-8131 WAD991281767 <br /> 9b.U,S.DOT DeSMWM#ndudhg Proper Shpping Name,Hezad(leas,ID Nwnber 10.ConbYrera 11.TSI 12;Unit 13.Waste codes <br /> HM andPammouD(ymoi')) No. Type Quari ty WGNd. <br /> 1'UR1951 IASTS A1110SOLS, ?LAIUTABLE 2:1 Off-*-V 8Q(D1$T=11) 4)/ DF811' 1115 0117 <br /> P- <br /> Aff 135' .331 <br /> 2•US1993 WASTE FLAMBIR LIQUIDS, 11.0.5. (ACS'1'011, RSTHIL 8T8LL �i 111 135 331 <br /> R4 ) 3 PGII (FLAURPOI8T-28.18C} 110111.111) 17N 1RZ P' <br /> 40 <br /> cl 3.02811 8AST8 TOEIC; 11WIDBr O1:GA191C,•A.0.8: '(2,1-11). 6.1 PGII .' 816 1116 331 <br /> 4.OR3266 11A$Tg C0180SIVR LIQUID,.BASIC;:IND @GAIOIC,.N.O.S..,( IUIE 112' 122•. <br /> X <br /> (1} R011S2.i-#ti B>18{126}' 080L8-ACC MATIO.(2j ROlIS3-14 '8114(128} F lI IAOSHPAC>< (3} 6.11-0.7. <br /> ,1191; (LIQUIDS MT) Aq HO ID-15:-•X110(156}•ALHALINS/C91110$IVK.1f.LOPOSAL#s:: t. <br /> 15. GENERATOR' ER0t'S CATION:t bydedare titat the contdnts ofthfs are"and aoaaatety desafbad above by Ore p w shlppkrg name,and are eluded,pecked, l <br /> rnarkort erxi ,end are h at raspeots b.proper oond�on for tranepo►t aocoldng te biteme�saf and natiorwl governmental regt4atMns.H expatshprnent and!am,the PrMrary <br /> f:x¢ortsr,i certify O>at the cont�s o!this oonslpanerdcordorm b the teims of the aOaclwd EPA. w b Corts�tt � )b hue: <br /> fl- oo*that Ore wash mWR Izaom statement Idanl6od in 40 CFR 282.27(a)(H i am a brge quanmy <br /> Oenerata aPrintedflyped a S M r. <br /> 9-�/-U- <br /> JC/ <br /> it.n Import te U.S. Export from U.S erdry/exh <br /> Tmnsporter lureBuil# Do"U34 <br /> 17.Tmmpw*Ad avMmeM of RaMpl of MaM* <br /> 1 Prbr owliae Mon Day Year <br /> Trier� �( 2 4 <br /> renspateT 2 am Month Y <br /> / Ira, <br /> i8, wer <br /> G� <br /> 18a.Ditsxepancy brdicsOon Space. ❑Q.* 0 Typ. l__t PWIdue. ❑Partial R*d4n ❑Fug Re)adm <br /> .. M Nufter: <br /> 18b.Alternate Fac ky(or Generator) U,S.EPAID Number <br /> eL Fade Phone: <br /> 1 o ate FacMy(or OmomtoO Irtenlh Oay Year <br /> x <br /> 19.Hazardous Waste Report Management Method Codes(Le,,codes for hazardous waste treatment,disposal,and mcYcft systems) <br /> H161 H141 <br /> 20.Designated Faa1Hy Ow wor Operator:Cwtlflcatlon Ot receipt rd hazardous materials covered by Ore utast excerpt as noted In Hem its <br /> P MbName S! Mo* Day Yw <br /> FPAForm 8700-22(Rev.3-05) Prefte editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> ' r <br /> Ly E;• <br />