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Please Ord or Form ned for use on elite 12- ch Form A OMB No.N]50 ap3g <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21 Genera6x 10 Number 22.Page 2 23.WnMeet Tre kWq Numbw <br /> (Coftnuatfon Short) CAL000018659 D f ^c 000265001 WAS <br /> 24 tMVITOLDINGS CORP. / DAWN JESS KMART # 3174 / MC&C CLERK <br /> `23 BEVERLY ROAD 2180 E. MARIPOSA RD. <br /> HOFFMAN ESTATES, IL 50179 STOCKTON, CA 95205 <br /> 25.Transporter Cornpany Name U S.EPA ID Number <br /> 26.Transporter Company Name U S.EPA 10 Number <br /> 27a. 27b.U S.DOT DwAxitttion(kukj*V Proper Shippkg Name.Hazard Class.10 Number. 28.Contwe m 29.Total 30.Und <br /> HU and Pecking Group(It any)) No. Type Quantity "Aw 31.Waste Codes <br /> X <br /> 5.5. 1RP�IIIi (TR'ICHLORD-STE S-TTRIAZINE"IO�IEN.OD'o, 11) 14 D00 <br /> ERG4140 ' e <br /> 5. 1RP&II3(HYbROGEN PEROXIDED SODIUM' N.O.S., 14 DOOIA <br /> HYPbCHLOAITE), (D001),ERG#14b t <br /> 7. RQ UN2929,161ASTE TOXIC LIQUIDS, FLAMMITBLE, D001 DO1 <br /> ORGANIC N.0.S. ,6. 1(3) PGI I, <br /> 135- <br /> 7. DICHLOROPHENOXYACETIC ACID), D001), XXX XX XXX X XXXX XXX XXX <br /> F ERG#131 Wf <br /> P)t' xxxx xxx XXXX <br /> U) N 8. RQ INOANUN3264,WASTE CORROSIVE LIQUID ACIDIC, 73 Dot) <br /> HYDROCHLOhIC*ACIb�8'(IC N0 b002�,ERG#154C bCID, <br /> O <br /> fO.NON RCRA HAZARDOUS WASTE LIQUID (LATEX 29 <br /> PAINT, DETERGENTS) <br /> �6o P <br /> le L1 AJ <br /> tsy <br /> I Io} P <br /> t1t U IOT-41 ase '� rs Z.i SIZE,411! <br /> I n"/O P T7 10 1 <br /> A,VAS15'x,!,1, , -Tem JOfp ey 2,�E !Y <br /> Ito Z3c- P 2 3 C Z3 P <br /> 043957§ LD 7.1413 0450310 LDR 8.W11 0450295 LDR r2r <br /> — 14.Iv2L4tri6lt I:OKg/ !t• !)cr$' �4c7D l L��w -41L / <br /> I,ccy(� ►x30 'xc-Y3 1-3.iZEF&fz +.��`� <br /> ¢ o Ix <br /> cc 33.Transppft AcLiowleclyned of RwW or Materials <br /> �u Prin"Typed Name Sgnature Month Day Year <br /> R <br /> Z 34.Transporter marts ct Recoo or Materials <br /> Printed7ypedName 39naut Month Day Year <br /> F– <br /> 35.Disaeparky <br /> J <br /> U <br /> a <br /> c <br /> 36.Haz*dous Waste R$ff Narrepement Method.Codes(i.e.,codes.l trardouswaste tr�L osp icf4rrng systems) g. H141 9. �i'�'1'4#—► <br /> N <br /> W <br /> c 10. H141 ►�. V�. �� �3, y <br /> EPA Form 8700.22A(Rev.3.05) Previous editrons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />