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269735 �-u 1146980 <br /> Peso print dr type. Form designed for ttse on ell"( pewriter. Form Approved,OMB No.20SH039 <br /> UNIFORM HAZARDOUS 1.Generator 10 u 2.Page 1 of 3.Emergenry Response Phone 4. Tracking NUM136f <br /> WASTE MANIFESTQN10=2 2.0 (8721 577-2662 007105448 JJ K <br /> 5.GeneraWs Name and Matting Address 4 Generator's SfteAddress(ff Afferent than mailing address) <br /> Rose-Depot C/O FSC Atte. Rome Depot CSR NONE DBPOT #RD1116 <br /> 5151 Stn Felipe NONE DEPOT #E1116 251 CON>IBRCS AVE <br /> GeRARRM11 77156 (3603113-7341 kWCA CA 95336 0151825-9139 <br /> e.TranspMer 1 Company Nana U.S.EPA ID Number <br /> 216t Comm awnwmamL NAwam or xvADA LT c CA M0164012 <br /> PqFName I r <br /> n <br /> B.Design ed Facility arta Site Address U.S.EPA ID Number <br /> GENERAL EIYIROMMAL NGT, LLC DSA PSC BNVIROIDI>f1TAL SERVICES <br /> 11855 IIRITE ROCI ROAD <br /> F sPhone:RANCRO CORDOVA, CA 95142 (916) 351-1981 CAD9M84183 <br /> 9a, 9b.U.S.DOT DwApilon(includi g Proper Shfpping Name,Hazard Class,10 Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Padang Group(deny)) No. Type Quarttity WUVOI. <br /> 5-6 1 9N1951 IMTE AEROSOLS, FLANKABLB 2.1 007-SPI28+42 19(D11741) loll 0115 0117 <br /> Do I 1F007 ( P <br /> Nllife RU331 <br /> 7-011993 WASTE FLAB (ACM <br /> R,LIQUIDS, N.O.S. (ACB, 19ML BTRYL Ili 0835 331 <br /> a RQ IMI) 3 PGII (FLASRPOINT=21.110) RQ(0111=111) ® I al11 P <br /> 3.UN ID N.O.S. (1Y=1 else -111413 <br /> S <br /> X P <br /> t . NareAmg eRa atdPddltlone )C 0 Irk <br /> (1) 2.1-14 - EH(1261 sols-A TIO (2) HM13-14 - (123) FLAWLE LOOSBPACK <br /> SOLID LOUSEPROPOSAL#: <br /> 15. GENERAT0R`3AffER10R'5CERT1FICAT10N:1 hereby dedam that the oonimb d this conelgmnent are fuly and accu atelydesaibeQ atwveby Me proper shipping name,Ord are dassl wd.padw*, <br /> matted and IatWeNplacerded,and me in pimp"in proper condition for lramporl according to applicable hrtemadonaland national govemmamal regulations.I wwrt shipment and I am the primary <br /> Exporter,Ice*that the contents of this consignment conform to the terms of the attached EPAAcI=wt <br /> t certify that the waste mhtmiza#on statarnernt fden88ed In 40 CFR 28227(a}{If I am a large quanl8ygenereto (b)(fft q garterabx)Is true. <br /> Gene atofsfOneW Typedgnature ay Year/7 Cc✓ 1C d <br /> 1e, maeonalShipstents ❑hrpwnl.U.S. ❑ExpwtfremU.S. Pat ofentryrexit <br /> llranspoder signature(nor expods a*). Data leaving U.S.: <br /> f7.TmuporterAcknowfedgmeatofReceipt ofMaterials <br /> Transporter Pring7jR Name SignaWre Month Day Year <br /> N)qakfNh EA S I&LQ& 10610 110 <br /> Tra 2 Prim Sire Month Day Year <br /> &.- , <br /> 18.Diecnepancy <br /> 18a.Discrepancy krAcadon Space ❑Quantity ❑Type ❑Residue ❑partial Reledion ❑Full Rejection <br /> Mardtesi Reference Number: <br /> 18b.Alternate Fac%y(or Genarstos) U.S.EPA ID Number <br /> J <br /> WE FadY,!Phone: <br /> reonih Day nature ofAltemate ad r <br /> 19.Hazardous Waste Report Management Metiod Codas(I.e.,codes for hazardous waste treatment,disposal,and mcydkq systterrts) <br /> C 1. 2. <br /> — I Heil Hill <br /> 20.0esignated PaciByOwner or Operator.CwHcatlaon of recelpt of hazandous matertds covered by the manifest except as noted In hem 18a <br /> Pn ha dffypsd � - sure pr <br /> EPAForm 8700 (Rev Previous s arVobsolati. D96ioNATEb 1WILITY TO DESTINATION STATE(IF REQUIRED) <br />