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r <br /> 970872 72515- <br /> Please pftt o Form desk ned for use on elite 12-pitch) eNrrlter. Form Approved.ONS No.2050.0039 <br /> UVIFORM HAZARDOUS 1.Generator tD Number 2,Page i of S.Emergem'y Response Phone ,ManifestTraacin�gt useer r <br /> CA <br /> WASTE MANIFEST OOM7239 2 (877) 577-•2669 0 0 5 61 6 3 4 0 J J K <br /> 6:Gerwrata's Name and MaiMng Address Qertenaora ale Address-ptddferantlhen malllnhg address) <br /> Holter.Depot.C/O'PSC,Atte. Hoole'Dopot•C811 HONK DEPOT IHO1016 <br /> 5151•San Fellpe H01<S DEPOT 901996•• 251 Comes'AM <br /> C*N, &4l 77856 (861.)303-7364 ILMTECA CA 95336 (209)825-9139 <br /> 6.Transporter Company WON <br /> U.S.EPA ID Number <br /> 21st CTNTERY ENVIRONMEN-TAL. MANAGEMEaTF OF NEVADA, LUC' MOM 64012 <br /> 7.Transporter 2 Company Nara U.S.EPA O Number <br /> r�aoa77a <br /> 8.DW§nated Fa Name and Site Ahtdasa U.S.EPA ID Number <br /> HOILINGTON >iAYII0NA8NTAL, LLC. IBNT FACILITY . <br /> 29215 TTTH pMUS'80UTH <br /> Face PlronaF&AT`,.BA 98052 (253) 872-8030 ...._._• <br /> ga. 9b.U.S,OOT Desor"m(Including Proper Shippinhg Name,Nazard•Class,ID Number, 10,Conga 11.Total 112 Una 13.Waste Codes <br /> HM srW Paokkr9 Grwrp(ff mry)) No. Typo Quentlty, WUVoI. <br /> 1 ON1951 9AST8 AEROSOLS, FLAW2.1 DOT SP'11296 IQ{D001=18M 001 10805 6087 <br /> IlIAB <br /> � /I p 0067,.:. D035>•-.,. 3�;::.:. <br /> U11993 NUTS ILAKUL9 Iflualff, N.U.S. TMIUBA, JIIATBIk ATRIk BE 0135--- 311 <br /> RQ 91TONA) 3'PGIrIFLASH@OIHT= 1".11 ' INDOIts-1e01 ' D p,al F Q45r p'A <br /> x —1011115:31ir <br /> 3. (BODIUK <br /> x 4 HYOIOXIDS, POTASSIUM.HYDROXIDE) 8 PGII IQ(D092--1001. 00 �ELO <br /> '�® F <br /> T4.Speda and o Information Ix r S" )j —I X`3 o "l) I x Is <br /> (1) 23-04 - SIG(126) OSOLS-ACCU RATIO (2) HOMS341 - SRG021) PLAMIS LOOSSPACI HOUGoss <br /> ¢' M1iY} (4) HORSflH-05 - SIG{154' ALIALIASICORIOSIV LFIOPOSALtt <br /> 16. GENERATORISIOFFEROR'8 CERTIFICATION:i hereby declare that the oontents of this assignment are fully and accurately dasQbed above by the proper shipping ria me,and are clesslfled,packaged, <br /> marked and NieWpNoardK and aha In al respects in proper condition for transport according to applicable krNmedortaiand netlorrd govemmental regvMons.N exportshipment and I am the Primary <br /> Exporter,i cerhiy that the contents of this consignment oonorm to the terms of the attached EPAAdvewledgmort or Conserrt <br /> I certl y that thaw"minimization statement Identified in 40 CFR 26227(a)(g I am a large grrartkygmreralm)or(b)PIjAn a smdl arator)is We. <br /> Generaot'stL <br /> Pd*dff Name to Month ay Year <br /> 1 C151 U 101 <br /> tr 16.IntematioTfal SNprnentsIr>apod to U.S ❑E)W Port of lexd: <br /> _. . ..Lmnswer iinatur-(foraxpod ordy)t.. 7/- _Date vbgUs <br /> a 17,TnernpoterAcknowledgment ofReoelptofMeNrfala V Of <br /> Transporter 1 Rome Signature Month Day Yeer <br /> N O --N A S 1 N ca r--efs-, 0'n26 101 <br /> imnsporter2 PilnWallyped Nan Signature Month Day Year <br /> — Z31 lof <br /> 18.Discrepancy <br /> 189, k�a1Nn Space ❑Q..t ty ❑Tyfe ElResidue ❑Pausal Re)ectNn ❑Fill Rejeeilon <br /> i <br /> Mant Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Fa call Phone: MoriffiDay er <br /> _. <br /> nature a adgly a ane<a <br /> ----TM0111-11- 11--- <br /> 19.Hazardous waste Report Maimpm ent Method Codes(f.e:,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. 3. 4. <br /> 2tr De�grret�FacHl'IV. eror epemia:Genf We n of mWpt4-)izardousirmic tsls oover d by lherman este as nded-kr -- <br /> ---- _........ -- ..._.. .... a ort ay Year - <br /> t1�1 VL <br /> EPAFohm870022( ev.3A5) PreviousedItIonsare obsolete, D SIGNATED FACILITY TO DESTINATION STAT (IF REQUIRED) <br />