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T - - 1 00 <br /> 293099 1167463 <br /> Please print or .(Form designed for use on elite(12-pitch ewriter,) Form Approved,OMB No.20SUB39 <br /> UNIFORM HAZARDOUS 1,Gerroralor 0 Number 2.Page 1 ol 3.Emergency Response Phone .Mora t rack ng umbar <br /> WASTE MANIFEST 007103785 JJ K <br /> S.Generator's Name and Mailing Address /Jj1 Genera s Ute Address((diKa ant maifng dress <br /> Home Depot C/o PSC Atta. Hole Depot CSI $ON& OSPOT 1201116 <br /> 5151 San Felipe sm D$POf dD11/6 51 CON ncl AYR <br /> Gen <br /> 6.Transports mpeny <br /> in <br /> EPA ID Number <br /> 21fit 92= LM CAR <br /> 12 <br /> 7.TransporW 2 Company Name U.S.EPA ID unbar <br /> •- ki MML.. GQoo 7q5,9 <br /> 8.Designated Fecr7dy Name and Site Address U.S.EPA ID Number <br /> G=M WHOR UTAL NGT, LLC DAA PSC UVIRO11R Ill 391YICRS <br /> 11851 MIN ROC[ WM <br /> F sPhone:NANC20 0011MVII CA 95742 916 351-1981 CAD91 4,Al <br /> ga. 9b.U.S.DOT Description(Including g Props SNp#g Name,Hazard Gass,ID Nurnbe, 10.0 11.TOW 12 Unit 13,We*Codes <br /> Jim and Pacldg Group(r any)) No. Quantity WI.Nd. <br /> 1-DI 951 RASTR A10601S, FLAMMABLE 2.I 19(11117=11f 111 0115 11117 <br /> X Er P <br /> 1-011I993 Nun FLinuiN L1mu, im. (num, OBTDTL HT211 Dr- loll 0135 331 <br /> RQ wag) 3 Pon (FUSDPOIlM21.11a) 10{0112=1111 ( 0 P <br /> 14,S Inatruc k no andAddlilonal Inlonarm <br /> (1) 1100B2.1-I4 - BUG(126) SOLS-ACC TIO (2) nmmi - HRG(128) Fuma LOOSHPw ( - <br /> 99 MIAMI '11111, 11 1 <br /> /1� 2 t>c <br /> 15. GEN GR'&WEROR'S CERTIFICATION:t hereby declare thalthe contents of Ws oomignmeni ne fully and ametaiydesofted above by the proper sNpping name,and are coed,parcelled, <br /> marked and tabeledrplacarded,and are in all respects in prgwr condillon lor transport accoAng to eppilcableirdamaflonaland national govemmantal regulations H export shipment and I em the Primary <br /> Exporter,I certify that the contents of this consbrmenl conform lo the teres of the attached EPA nt of Consent. <br /> I cwtily thal the wage minimization stalermeni lderrilled in 40 CFR 26127(s)lif I am a large quantity gemrator)or(b)(#1 am a small quarrtlygenerator)is true. <br /> 2 <br /> jn �ypld No" Month ay <br /> f16, temationail Shipments� ClImport to U.S. ❑ExpM from U.S. Port of antry/etoc <br /> $ Trarrapods signahee(for exports my): Date laaving U.S.: <br /> V.Tranaporlerftnowle%wwA of Receipt of Materials <br /> ransporler 1 Marne Sfprtalura Month ay Year <br /> G o%6eT A , 107 111 U12 <br /> TraP3t�Narnce� S�rreWre Month Day Year <br /> r - j <br /> 18.Discrepancy <br /> 18a.Discrepancy htdlsatlon Sppoe Quantity Residue❑Residue ❑Partial Rejection ❑Ful Rejection <br /> Manifest Reference Number: <br /> IBb,Allemate Facility(or GOWE110r) U.S.EPA III)Number <br /> V <br /> W FaciAy s Phone: <br /> 8c.Signature of lemate Fad or Generator Month Day Year <br /> z ' <br /> 19.Hazardous Waste Report Management Method Codes(ie.,codes for hazardous waste treatment,disposal,and recyding systems) <br /> C3 1. TIM <br /> 2141 2141 <br /> 20.Designated Facility Owner or Operator.Certitimllon of receipt of hazardous me lariats covered by the manifest except as nod in Item IBa <br /> Pei Name � ire re N �Y� <br /> I <br /> EPA Form 870D-22(Rev,MS) Previous edfions are ob ete.. 1ASIGNATED FACILITY TO DESTINATION STA E(IF REQUIRED) <br />