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t� <br /> 3425933 <br /> Please print or type. v JJ Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2, Page 1 of 3. Emergency Response Ptwne 4 Manifest Tracking Number c {[ <br /> WASTE MANIFEST 017 4 f 1 7 V 9 JJ K <br /> 6. Generator's Name and Mailing Address Generator's Site Address (if different than malting address) <br /> Orchard Supplytif#U530 do Sterieyde CSR Orchard Supply010530 <br /> 6151 San Felipe St Ste 1000 . 189 W Louise Ave <br /> JJ%*pJK 77.050 (18172) 677,21VID anteca, CA 95338 <br /> 6, Transporter 1 Company Name U.S. EPA ID Number <br /> 7. Tran 2 Company Name U.S. EPA ID Number <br /> leor4sio SOP so A W" F .� v ►.�s 0400/ C <br /> 8. Designated Facility me and Site Addre U.S. EPA ID Number <br /> 2151: Century EIVII <br /> 2095 Newlands Drive E <br /> Ft, NV 89408 <br /> Fad ' s ne: <br /> 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit <br /> HM and Packing Group (If any)) No. Type Quantity WL/VOI. 13. Waste Codes <br /> 1. <br /> o UN3175 , Waste Solids Containing Flammable Liquid, N .O .S. , 03 DM 800 P <br /> 3001 gal <br /> 4 : 1 , PG it <br /> UJ 2. <br /> W <br /> 3. <br /> 4. <br /> 14, Special Handling Instructions and Additional information <br /> FIa #fi0SHF'LAMS0L-04 <br /> 20 #K3425933 ` <br /> �'i8-18558 <br /> 15. GENERATQR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuratelydescribed above the proper sh name, and are classified, packaged, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport aaordirg to applicable intemationaland national n I a export shipment and I am the Primary <br /> Exporter, l certify that the contents of this consignment conform to the terms of the attacked EPAAdmowledgment of Consent. <br /> 1 ow* that the waste minimization statement identified in 40 CFR 262.27(a) (If I am a large quantity generator) or (b) (RI am a smai ) <br /> Generatoesl0l(eroes Printed/Typed Name Signature Month Day Year- <br /> 11 <br /> ick Vatxari on behalf of Orchard SLodYN530 'e 112 11A 148 <br /> iJ 16. Intematianal Shipments ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit <br /> ME Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. TranspokterAcknowfedgment of Receiptof Mauls <br /> Transporter 1 Pdnted/Typed Name Signature Month Day Year <br /> 0MI Jlck Vaooari 112 ' 14A 14A <br /> T 2 PrintedlTyped Name Sign Month Day Yea <br /> 9 / <br /> PaanY <br /> 18a. Discrepancy indication Space ❑ Quantity ❑ Type ❑ Residue Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 18b. ARemate Facility (or Generator) U.S. EPA ID Number <br /> J_ <br /> Lim <br /> V <br /> Facity's Phone: <br /> W 18c. Signature of Aftemate Facility (or Generator) Month Day Year <br /> a • <br /> z <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste Usatment, disposal, and recycling systems) <br /> p 3. 4. <br /> 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Rem 18a <br /> Pdnted/Typed Name aiure Month Day Year <br /> r4r1Jl & )(U W_ _N A)-Y= I V_09= <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br />