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-386850 Q �� 1e72768 <br /> Ploase printtr type. Farm designed Kruse onellte 12 Itch ewrhr.) Fam roved,OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Geramtor lO Numher 2.Page f of 3.Emergency Response Phone 4,Menl/aet TreckE Number <br /> WASTE MANIFEST CM000171645 2 (877 577-2669 006435414 JJ K <br /> S.Generefare Name and MellngAddrae9 Generators SlIs Address if dIfforentifien metiing Wen} <br /> Hoge Depot C/O PSC WTI. Hone Depot CSR HONG DEPOT IRD5576 <br /> 515I San Felipe HONE DEPOT 4HU5576 701 D'ARCY PARKWAY <br /> oem;m*.wkIboi TR 77056 (866)313-7344 111THROP CA 95331 (Z04 858-5513 <br /> B.Tiansporter l Company Nems .S. ID Nuntlow <br /> s v r 4 <br /> 7.TraropaW 2 Corrpery Name U.8. AID Number _ <br /> /- }.f 2- l2 BU4 5a <br /> S.Dsegretad Foci Nemo an 8 Addreee U.S. PAID Number <br /> BURLINGTON ENVIRONMENTAL, LLC. HEAT FACILITY <br /> 26245 77TH AVENUE SOUTH <br /> Fecl Whom:REST, NA 98632 (253) 872-8030 WAD991281767 <br /> ga. gb.U.S.DDT Dos rlptlan gndudng Proper SNppin9 Name,Hazod Gees,ID Number, 10.Contalmrs it.Total 12.Unit <br /> HM and Packhl9Gmupgfany)) No. Type' Quantitywtivd. 13.WaekCades <br /> 1. TA AEROSOLS, F AMMA L . 296 RQ <br /> X DF P <br /> ec"o 0008 8036 331 <br /> 2 <br /> R KETONES 3 PGII (TR SHPOINT=20.000( -*R4U--,00( f aF P <br /> I <br /> 3. , r r , , - <br /> q X eT <br /> V <br /> 4. 2 <br /> X H _ , v ad OXIDE) 8 PGII RQ(0002-100( <br /> 14.Soodal HandlN9 lnabuceons and AMdonal Information !i <br /> (1) HONE2,1-04 - ERG(126) ANROSOLS-ACCUNULATIO (2) HONK3.04 - KRG(128) FLAMMABLE LOOSEPACN (3) H011E6.IL-84 ERG(153) <br /> T(IIIC (LIQUIDS ONLY) (4) HONESB-05 - RIG(154) ALKALINE/CORROSIVE LPROPOSAI4: <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare thatoe cofthofthfs conslgmreM sm Mllyand accurately dearubad above by the pmperftft name,and are desoMed,pachNK <br /> marked and labeled[pleaded,and ere In all respecbh propercond0ei kr tromped armNing to apdicable lntemational andnadmal governmental rogulagom.Ifaxpon sh*wt and l am the Primary <br /> EVorlet Nar9fyInatmemntenle of this uansigmrM=fomr tock forme of the aeeched EPAASMae1edgmem of Consent <br /> IcerfiylhatNeweslerdnOdm$DnstatemwtMm6fled N40CFR26217(a)(Hinalerga WanCrygenemtr)o(b)Alame al prenldy garceralorl la fine. <br /> GeNacre Mand Day Year <br /> -.r 18.Intamegonal Shlpmanl5 ❑ImpodtoUS ❑Fowtf .S. f Panolen5yAdl: <br /> Transporter eignahre(for exports only): Datelsaft U.S.: <br /> De 17.TrenspoAarAckncv4edgmeatof ReralplofMat5rWa <br /> Transported R ntaciRp Name Slgnalu Mon Day Year <br /> aa►1 `- 9' <br /> 7j. Traneponer i ype a - N /� Month Day Year <br /> ...• I ed-r-1r .. Aug-`- <br /> 16.Disaepency <br /> 18a.Disaepanq ladlradon Space ❑ Omaity - El Type ❑Residue ❑perdal Rejection ❑RM Raid., <br /> Menhest Reference Number. <br /> 181o.Ahemele Foay(or Genwator) U.S.EPA 10 Number <br /> U <br /> Fec7ys Phare: <br /> @ 18aSignature ofAlarnate Fechily for Generator) Mono Day Year <br /> CD2 <br /> 19.Fkmrdom Weak Report Management Method Codes Q.a.,codes for hamNnusvrade ueaVnemL disposal.and mgdta9 systems) <br /> G 1. 2. 3. 4. <br /> H141 I H061 H141 1 H141 8141 . <br /> 20.Designated Facility Owner orOperator.Cenftdw of mcnftof hawdous malelals oaversd by the menbstMats as need N Item lase <br /> RNkd yped Nemo axh Dey ear <br /> MON-1 MU Sign kl1 1I (O <br /> EPA Form 8700.22(Rev.3-OS viousedldons am obsolete, Dw*NATE - dCILIT' TO DESTiNAT10W STATE(IF REQUIRED) <br /> CG 1�.F_AN i4pM5:I <br />