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0203 839545 ... „.,, 'Approved. <br /> 22�Sg�, <br /> Please pdnbar pe.(Form designed for use on stile(12 <br /> -pitch)typewriter) Form Approved.Ohl9 0. 60-0039 i <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Pagelof 3.Emergancy Rimponse Phone 4.Menlfaet Tracking Number <br /> WASTE MANIFEST ggloi .,0,0 3 8 9 2 8 2 7 JJ K <br /> S.Generators Name and Mailing Address Generators Site r ss(iffifferionfffin mailing address) <br /> ROM9:DEPOT CID-39 COMPANY ROME.DEPOT I <br /> 1905 ASTOR AMOK t100 701 U'ARCY PR9911AY <br /> Generelar i <br /> fi.7ranspo er ompany arae plawl 8316 - . . ID Number <br /> 1 <br /> 7.Trans 2 Company Name U.S.EPA7 D Number 1, 7 �/ ' <br /> 7fj � Yes1 V r(.QU 6 1 / �0 <br /> 8.Designated Fri Name and Site Adtlress U.S,EPA ID Number <br /> BURLINGTON HIMAONXENIAL, INC. SENT FACILITY <br /> 20245 77TR A0ENU9 SOUTR. : j <br /> WBl9T;l`WA.98032 (2531( 872 8080.:• r., e wk M99128L767 f <br /> FacillHs Phone: - <br /> ga. 91b.U3.OOT Descnption(Indutling PropershippNg Name HeIDrd Gess ID-Number 10 Cdnlalnem 11.Total 12.Unit 13.Waste Codas <br /> HM and Packing Group(if any)) W. Type Quaollly wuvol. <br /> iNlilcill WASTE: AEROSOIS --434, <br /> F R'l 7 1 nag RPI i. . . -.-,.b..n :if..:xl (A tiv I,rs, gwni, it <br /> 2. UR1263.WASTE PAINT RELATED MATERIAL 3 PGII -RQ(000! 100( rit 8001, 0035 331 <br /> c0� ...... •t - ''AQ w'trs.,nhit"i : r � ;;0)^'�.00. ,.ps„ <br /> 3' jM207 VA.IVRr r r r r D0 <br /> 4. UN3266 WASTE CORROSIVE LIQUID, BASIC, INORGANIC; 104..S (SODIUM - D002 122 f <br /> RYDflOWIDS yPOTASSLOM RY0R0YI0E)..OeBGIL RQ(0002=100(? t .dQ.�x-e $ i <br /> Z,040--- '- Fill <br /> 14.Special Handling lnsbuctrasandAddlhonalInformation x)-6XS 1)(15' - <br /> u vn+xrx+ e, a rf+n etroncnre•-(,2)i NOM93+83 ERG(138) FLAMMAE19 600NSPACWv(3)% ir-� <br /> BW66fiM08•(4)'HOM98B-03::-BRG(154) AG9ACIN9/COR�USIY9.RPROPOSADA.24,RO0A;:9M9RG�VCYCONTACT .(000i(C-'45L8346:-=; <br /> 15. GENERATOR'S/OFFEROR'$CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name and are classified,packaged, <br /> marked and labeled/piacarded,and are In all respects in proper candifion for transport exarding to sppllcabla Inlemaromdand abonal govemmemal regulations.If export shipment and I am the Primary <br /> Exporter,)cetify Nat the contenaofthis consignment conlomi m me terms of the attached EPAAcknowledgmento • <br /> centlfy that the waste minimiralian assessment Identified ln 40 CFR 2622T(a)(ifla1. <br /> me large quantitygenemlar)or )' an a miuly genemen)is We. <br /> Genemloesl es Printed!! d Niles urge Month Day Year <br /> 10.International Shipments <br /> F- ❑Import b U.S. ❑Exporteam U. . oRtfenby/troll <br /> Transporter signature(for exports only): Date leaving 0.S.: <br /> W 17.TrsnsporterAcknowledgment ofRecelpt of Materials <br /> Traneportert Pdnt.MWed Name signature Month Day Year <br /> a 'N Sitj <br /> Z Transporter 2 Print ped Npam,eSlgna; Month Day Year <br /> �' D.�' •2Y o <br /> r <br /> 18.Discrepancy <br /> 10a.Olsuepancy Indication Space ❑ Quantity ❑TyPe El Residue ❑Padiel Relacgon ❑Full Refection <br /> Manifest Reference Number. <br /> 18b.Allemam Facility for Generator) U.S.EPA ID Number <br /> 7 <br /> v <br /> LL Facility's Phone: <br /> w 10c.Signature ofNternata Fadfity(or Generator) Manila Day Year <br /> a <br /> z <br /> m19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1. 2 3. 4. <br /> 20.Designated Facility Owner or Operator:CeNfication of mceipl of hazardous materials covered by the manges)except as noted in 0 1 B - <br /> 'IIIY dntedRyped Name signature Month Day Yeer. <br /> t LGY4J <br /> EPA Form 8700-22(Rev.3-05r Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />