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Form Approved.OMB No.2050.0030 I <br /> B water. 4,ManifestTmaking Number <br /> Please prjntar e. Form designed for use on elite(12•piah)Npe ) p,page t of 3.Emergecry Response Phone <br /> t.Generator lD Number (g77) 577-260 004948582 JJK <br /> UNIFORM HAZAft0003 MON171645 <br /> WASTE MANIFEST �S GaneraWls SileAddrass(I,,sa ethos mmlinp atltlrass) <br /> 5.can'ators NameendheaEngAddress HOHR DEPOT IBB5576 <br /> HONG DRPOT C(0 3R COMPANY 701 D'ARCY PARHNAY <br /> 1905 ASTON AYEHUR 4100 L&ISROP CA 95330 (209)858-5513 <br /> Geneiat0 CA 92008 (808)451-0346 us.EPAro Number ' <br /> a.Transporter I COmpany Name . OF NEVADA, LLC cAR000164012 <br /> 21St. CMWMY_1�x1VIRONPIENTAIa MANA(S• ]sjrU!S.EPA tO NumCer r'�) <br /> 1.Transporter 2 CWPanY Name <br /> CUS.EPAIDNumber, <br /> B.Deslimma Will said SlleAddrese <br /> BUBLINGTOH ENYIROHIMHTAL, LLC. HRHY FACILITY <br /> 20245 77TH AYRHUR SOUTH ( F7AD991281767 <br /> Fadi/srhone: UHL NA 98032 (253) 872-8030 . _ l0,conferees 11.Towl 12.Unit 13,N7astaG s <br /> go, 9b.U.S,DOT Desorption imcluding PreferS*0,9 Name,Hamed Class,ID Number, No type qumg)y W IWI. <br /> HM and Packing GmuP fr!any)) L-HBTB Ila <br /> 1. <br /> g D001 0435 331 <br /> z a US1263 NASTR PARIT RRATED RATERIAL 3 PGII R410061=100) <br /> R <br /> 3 <br /> HAStC TNORGAHIC;R�:S rtSODT P <br /> i 4. WASTLrCDl7RUS1YEZIQDIT, ttlltuuB <br /> V x r <br /> 14,Spedal Handling Iassrvkv,oldAddl&Uk information °�X�$� nrrcor xvsvir <br /> RRG(1281LPROP 6ALt;L00SB�PmneCH <br /> ' packaged, <br /> ard <br /> 15. GENERATOR'SIOFFEROdd ERTIFICAall raspeca nbPrepeecandigor.roroUanspadfawording 10 aPDlkable intematbnvalaod nalmmafagovernmenahreguatlors..fl(expait P�nt arq�am Mary <br /> marked and aheleNplacw nuantlt generator)Is Ione. <br /> Erred%l wity that lha contents of mils wrrsigmnem wnforre WNe arms of the stashes EuAAdm eras.2�toraafo)�n90n smog Y9 Month Day Yeer <br /> I centy last tesv.Rea minimlaelkin statement idenmfed In 40 CFR 282.2i(a)lm i am a largo q y Si9nstwa <br /> Genemfotsl0me ' 'naN(yped Namer <br /> 15Inaa fenWxb <br /> . mamone,Statements Esyon law U.S. j <br /> i— ❑Impod to U.S. DaW Iaevlrg teU.S.: <br /> Z Transporter W911110(for exports w,lyj: Mcnlh DaY Yaar <br /> W 17,TrenspaderAckmWedlimenl of Receipt of td <br /> atenals Signature t a� lg b' �� <br /> Tranapoder 1 PrmmedTyW Name of ✓ <br /> NA N IZ s ! sreaae � .. <br /> Trensporter yped Name r <br /> f w <br /> i 18.Discrepancy !--1 ,❑Panal Releclbn ❑FOf Rejewun <br /> cre <br /> ❑Typ IJ ' <br /> tOa,DlsParwy lMlcation Spew ❑ quantly Residue <br /> r � Meekest Referenm Number US EPA.D Nuni <br /> I ! <br /> 1I � <br /> "SeAlternate FsailllY(Or Genwefw} <br /> i � U Month Day Year I <br /> LL Fecddys Ptane: <br /> } 18c.Slg,ors 0 Altamaha FK114(Or Genamlor) r <br /> f a <br /> Z <br /> f <br /> N 19.HemNws Waste ReportManagement Memrod Codes lf.e.,vides for hamMous waste Vestment,deposal,and rending sysRms 4 <br /> 2 3. <br /> � I <br /> Modh Y/y <br /> r I <br /> 20 Designated Fatlldy 0v+ner or Operator.Grlilicallonof rereiptW hemrdous matarcafe wvored bylM mSlgnmusx as need ir.11em � r <br /> 1 l af <br /> P yped Name — f <br /> SIGNATE, FACILiTY TO DESTINATI ST E REQDIRED) <br /> {l EPA Form 8700- 2(Rev. 5) Previous edllions are obsolete. DEC7�tXM i7 <br />