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863071 87889 <br /> Plaeas print or typejlisg designed for use on elite 12-pitch) ewdter. FormApprov3d.OMB No.2050-0039 <br /> UNIFORM1 AMOUS 1.Generator ID Number 2.Peg s1 3.Emergency Response Phone .'onset UI®Ong um6ory� <br /> WASTE MANIFEST CARM171645 (877) 577-266`- ®0 3®93'340 JJA® <br /> 5.Generetds Name and Making Address Gsneretola Site Address(itdlRerent than elegant address) <br /> ROB 0004 C/O 39 COMPANY HOME DEPOT 1IMS576 <br /> 1905 ASTOR APBDAE 4106 781 O'ADCY PAWAY <br /> Genua e�io�� U 92118 (8011451-8346 LATHROP CA 95338 (209)858-5513 <br /> S.Transporter Company Now U.S.EPA ID Number <br /> 21st CIN'1 M M9 CARM164012 <br /> 7.Trane ner2 Com ny Name �� US. A ID Number ,} 77b <br /> (C^ V a <br /> 3.Designated FecWy,Ne a aAd Site Address U.S.EPA ID Number <br /> H01LINGION MROENTAL, INC. 6RUT FACILITY <br /> 28245 77TH BOBS SORTH <br /> FaNklesPhone: 1EN4; Wk 98132 (253) 872-8131, WM91281767 <br /> tie, tib.U.S.DOT Oeecrlptlon Ilndudfite Proper5hipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> HM mMP8dUn9GouP(deny)) No. Type Quantity Wf.Nol, <br /> 1. 811951 MASTS AEIOSOLS, FLAMNABLI, N.O.S. (NN?HYL 6?HYL 16?ONE) 0181 0835 331 <br /> 2.1 004-SP12842 19(0111=110) oor� P <br /> [° IF <br /> O a <br /> Z. 811263 WTH PAIR? IELA4ZO HATMAL 3 PGII 19(01/1=111) D111 D135 331 <br /> 0 R ®O 05'100 ga <br /> 3 S' <br /> Y 891111i=Lt) <br /> d 3266 >S <br /> 14.Spedel Haadnnglnmdosand Addlticnallnfmmedon -t1 '37( <br /> (1) 001112.1-1113 - 680(126) AEIOSOLS (2) HOH63-033 - 019(128) 3LAML1 LOOSEPACE <br /> LPIOPOBIll HOBO MGBACY CONTACT: (SIB) 451-8346 <br /> NNS <br /> 15. GENERATDR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of Nis conslgnmenlare fully and aocurately described above by the proper shipping name,m°am dessiiled,packmged, <br /> marked and labaled(pleceNed,and"In all respects in pmperoondition foreanspmt acrnNmg to applicable International and national governments]regulators.If export shipment and I em the Primary <br /> Exporlen,I certly that the contentsof this oanslgnment conform to the terms of the attached EPAAdalmledgmant of Consent. <br /> I osNy that the mote unnimiratbn statement idenlMed in 40 CFR 282.27(a)(if lam a large quantity generator)9,Wift am a small quantity generator)is true. <br /> Genera mis nnteNlyped Name Sign Mont Day Year <br /> ES Q I'4- 0V <br /> -a 16.lnlemaganel Shipments <br /> ❑Impo ❑Fxpod <br /> to U.S. from U.S. Pmm.hyleut <br /> F- rt <br /> = TMISP11 ter signawre(her exports only): Date leaving U.S.; <br /> K 17.TransporterPrJmwAedgmant of Raceiptof Materiels <br /> Transporter l PrintedrTyped Name Signature ManN Day Year <br /> H N Pr N a, <br /> 2 <br /> Transporter 3 Ptlnted?ypetl Nama ,$jppti _...� ayN Day Year <br /> 19.Discrepancy <br /> 789.Discrepancy Indication Space ❑Grentity ❑Type <br /> ❑Residue ❑Partial Ra)edbn 0 Full Rejection <br /> Mankind Reference Number. <br /> Ibe.Alternate Facility(or Generl U.S.EPA ID Number <br /> V <br /> ra+. Facil9ys Phone: <br /> 18c.Signature of Alternate Facility(or Generator) ManN pay Year <br /> 2 <br /> S219.Hazardous Waste Report Management Method Codes(i.e.,codes for hazedous waste eeaenem,disposal,and recyding systems) <br /> 1. 2. 3. d. <br /> 20.Daalgnabd Facility Omer or Operator.CertlOcason of recegtafhwNaue tnabdeh covered by the manifest except as noted In Item 1B <br /> note ymdName Signature Month Day Year <br /> C hr f s1 he- A_ G� i sc�S b/�o oT a <br /> E�PAFAaF�/on'n 8700-22(Rev.3.05) Previous editors em obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />