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T 4 <br /> • /uco t 893502 • -' 80314 <br /> Form Approved.OIdE No.2050-0039 <br /> Please Print or type(Form designee for use on stile l2Fllch)typBwrltecj 2P Page 3.Emergency Response Phone 4.tdanReat Tracking Number <br /> UNIFORM HAZARDOUS 1,Generales ID Number 005028548 JJ K <br /> WASTE MANIFEST CPZ0001716. 7 <br /> S.Gxneratw'a Name am MelUngAtldrass PIS "I"..a 811e Address{il d!merenl gum ma3ing address) I '! <br /> HONE DEPOT C(0 3H COMPANY NONE. DEPOT 4HO5576 <br /> 1985 ASTON AVENUE 1108 701 D'AACY PAARHAY <br /> LATHROP CA 31a (m) <br /> GnrewaU.S.EPA IO Nmnber <br /> 1umrpany Name <br /> r r ; LIZ l <br /> .2'15t y - U.S.EPA IO Number <br /> 7 Transporter 2 Company Name r '? i,��110 <br /> US.EP N0 Gmhher <br /> 8.Oesignared Wall Name am Sge Address <br /> BURLINGTON ENVIRONMENTAL, GLC, RENT FACILITY <br /> 20245 "7TH AVENUE SOUTH WAD991281767 <br /> Fariety'a Prune. RENT, NA 98632 (2531 872-8038 <br /> S.DOT oepsonincluding Pricier Shipping Name,Hazard Class,lO Number, 10.CaAenam 11.Talar 12.Unit <br /> 9a. 9b.U. a13.Waale Codes <br /> N". Type (blindly WUVd. <br /> Nht ' and Packing Group M arN)) <br /> 1 UN1950 WASTE ABfltlSOLS, FLAHNABLB, N.O.S. METHYL BTHYI, RBTONH) 0801 0835 331 <br /> o .1 OOT-SP12642 RQ(0001=100) pb CO �j0 P <br /> ad 2 <br /> 2. UN1263 HASTE PAINT RELATED NATHRIAL 3 PGII 19(0001=100) F 0081 0835 331 <br /> sa4,. 030o P' <br /> � g D <br /> I4. M1325C WASTE CORROSIVE LIQUID, BASIC, IN GAMIC, N.O.S-. (SODIUM OA02 L22 <br /> X I HYDROXIDE, POTASSIUM HYDROXIDE) 8 PGII RQ(0A02=L0A) O o I G O j 0 P <br /> 14,Special Handing Instructions and Additional Information s } <br /> (1) HONH2.1-63 - SWIM AEROSOLS (2) HONH3-83 - EIG(128) PLANNABLS LOOSHPACH <br /> (5I$H'IB9-ONL'4i (4) HONH813-14 - ERG(154) LPROPOSAW <br /> 15. GENERATOR'SIOFPERDR'SOERTIFICATION:Iherebydedsret...the mnlenlsd,`As corai9lunenl are luUyand accurelaty descrbed abw¢by Na proper 9umping name,and are dessifed,Packaged, <br /> muked ard!abaridlPGcemctl,"are in at reads in Proper rnrvdllion for b-,l eaongng to applicable i dematimal and r2Uonal gwemmadal ragvialbns,if expcn slupmanl sari!am ale Primary <br /> Egfxelhal <br /> I wmA'Thal Ue cunlen!a of 116s runsynmonl oonbrm le the terms of Ih¢aXached EPAA.eknwAadgmenl of consent. <br /> i cadiry lhmiys w4s;em:nim¢ution sl&Iemenlidemifredin4OCFR262.21!e){Alamo sign Glmntity gone her}ar.(bY6fla asmnll qunnU,y gene2lwjie live. Mem Day Year <br /> ed Name Signature <br /> Gancrahl;ICMvwIS Prinle�P 4 L_ -�/ (I 05— 0� ; <br /> IL ��n;rS <br /> r� 16.imemamnal SlhlPmenta LJ Import to U.S. Exp MU from U.S. not mtrydexib—� -- <br /> z ate leaving U.S.: <br /> i — Transporter sgnelure liar expwis Cnlyl: <br /> ! w 17jonadporterAckwnledgmamo(Receiplo(MaledNs hfowh Day Yaar <br /> C Transoorer I Prinledl'yped Name /2 <br /> 04 <br /> S'gnalu2 � <br /> O N - iJ - /'- N C1 S 0 3 <br /> a <br /> aTrade) - mtedlTypo Name Slrplalura a IMpn� I �a I� <br /> t13.Diw.mpw.v <br /> ;yn.LiwcgmlcylMicalicn Spew i� Oumuiiy, ED]TypeResales UPartial ReymUal Full Rejecial <br /> Merited Remence Number. <br /> US.EPA ID Number <br /> 181S.Aitemale Fadlily(w Generator) <br /> � I <br /> U <br /> ua. Fazg6ys Phone: - Menm Day Year <br /> w 18r..51gnaluce ei Alternate Facility(or Genemlw) 1 <br /> 4 <br /> z <br /> vw—i ;g.Hazardous Waste Rup¢d Nlanagantenl McUmd Codes Ce,codes lar hazardous waste Sediment,dims <br /> and recycling SOWS) 4 • <br /> i wl <br /> 7.0.pedgualed healthy Owneror Operdol:cerIM¢al'ronof receiptothazardous matoalscosiored by the manifest exgept as tided in Item tea Month lay Yee, <br /> PinledRyped Name Sgnalure <br /> r <br /> EPAFornl 8700-22(Rev.3-05) Pravioos editions are obsofate. pESIGNATED FACILITY TO DESTINATION S7ATE(IF REQUIRED) <br /> f <br /> NOV 11 AM 5:31,._ . �, <br />