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• <br /> ` S LTA 761 6 869493' - 55723 <br /> Farm Approved OME No.2050.0039 <br /> Please print or type.(Fan deal ed for useon elite l2- Itch ewdfec) <br /> UNIFORM HAZARDOUS 1.GeneramrlD Number 2.Pege7 of 3.Emergency Response Phone oat Trachin Number <br /> WASTE MANIFEST C OW171645 877 577-26 -":;0 0 4 9�5 0 6 4 2 JJK - <br /> 6.Generata'sName and MAN Address Ga emloes SileAddinss(it different than made address) <br /> HONE DEPOT C/O 33 COMPANY HOME._DEP0711195576 <br /> 1905 ASTON AVENUE 1100 701 UsARCY PARKWAY <br /> GenemaORLUMD CA 92008(8001451-8346 L THROP CA'4 9' <br /> $,Tmnsponer t Company Name U.3.EPAID Number - [_ <br /> mm <br /> 7.Tre porter 2 CoalYY gff <br /> nMU.S.EPA ID Number II <br /> G �p ; 4 addab 270e 1 <br /> 9.Daslgnated Fadilry Name AMSIIeAddrees U.S.EP IO Number <br /> BURLINGTON ENVIRONMENTAL, LLC. KENT FACILITY <br /> 20245 77TH AVENUE SCUTH- <br /> Facial'a,"A: KENT, WA 98032 (253) 872-8039, •' WAD991281767. i <br /> 9a. <br /> 9b.U.S.DOT DesmPica(Yduding ProperShlppnQ Name,Hazard Class,ID Numhec 10.Containers 11.Tow 12 Unit 13.West Codes <br /> and ParFm9 Group(genYl) No. TYps I Qua<Nly WLA7d. <br /> i <br /> 1. q (11971471 EMT.;100199)-L� <br /> H GT-Se _ r <br /> z 2. UN1263 WASTE PAINT-RELATED HATERIAL1 PGM RQ(➢@01 1001-.•W 1� �"���<;t• d '. .a,�,r., �-'^ -D®M,, -0935:•' 331=ILIx: <br /> , <br /> P177 e <br /> a. UN3266 NASTE'CORROSIVE:LIQUID <br /> 1:BASIC'tINORGANIC) M 0 3'i1>(SODIUN a - -` S " D002" :i22; <br /> X HYDROXIDE, POTASSIUN HYDROXIDE) 8 PGII RED002=100) co ( 0(00 P <br /> 14.Spedal Handing lnffiucb'ans entlAddlhanal lnamtaUal ))'?(rj'S' (X 4 'I <br /> 11 HDNR2 t 6q annnar_s_a-aneenrg 2 -NOM83-03s,-. Bfl6 12fl FLANNABLK°.LOOSKPACK!' - <br /> �IQU488-9NirYl'141 Ii0HK8K-04t KRG(l54)' ALKALINE/CORROSIVB'tiOROPOSALO:• '=`. ` <br /> 15. GENERATOR'SIGFFERORS CgRTIFICATIONt Ihereby declarethalthecoments ofthleconalgnmemarefui and accurstaydaserbed atomsby Ne mmershlpping name,And araclassifted,packaged, <br /> marked and abstedt-Wiparded,and mein At respada In enter motion for asrapone,acorom;to applicable international and MIAMI govemmencal regulations.If export shipment and tem the Primary <br /> – – --�Exponer,lttvh of wTl5afi5fs consignm�en wn rmo a dmaoNhe ah11a3m�EPAAcMridFlea�i t-6fCU59flt-- —"—'—r <br /> I carldymetfh Van stetementldengaed in 40 CFR 26227(a)(ff l am a large quantity generator)of(b)(fl,am a smell quantiry enomtor)tstnre. <br /> Generate OHerg ed Namo 9gna adh `ay Year <br /> O <br /> J 18.Int M <br /> L1 Import to U.S. ❑Exponfrom U.S. Pan of enbylaxlt. <br /> Tmns sig ae(forexpons only): Date lem4ng U.S.: <br /> 17.Tre ponerAckmniedginentofRecelpoWlatai <br /> Tre deri Plotted =pail Nemo Signature Monty Day Year <br /> Tran r 2 PdntedRyped Name - Signature ManN DeY Year <br /> 18a.Discrepancy Indication Spam ❑Quantity Type Residue ❑Partial Rejecaan ❑Ful Reaction <br /> Maddest Reference,Number. <br /> taro.AXamate Fac py(or Generator) U.S.EPA ID Number <br /> U I I <br /> LL Faclllhys PtNne: <br /> tee.Slgnatme ofAHzsnale Facility(or Genaralart Month Clay Year <br /> 4 <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes Qa.,codes forhazmdeus waste bezlmetl,disposal,and recycling systems) <br /> a 1 Z 3. 4. <br /> 20.Deggnated FackyOWnererOperata[Congestion of'm"lpioNmdousmetenak$ vdmdbyl emptm Mod A Item laa <br /> Privd am kA � Sign re y <br /> 'I,{Y e � MaMh 0 e <br /> EPA Form 870(r-22(Rev,3-05)PleWous editions A obsolete. DESIGNATED FiAOIUTY TO DESTINATION STATE(IP REQUIRED) <br />