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, . 3oa3Q <br /> " 1092264 <br /> 208496 9 n Form Approved,OMB No.2050-OD39 <br /> to so riot or type. Foran designed for use on eflte 12pitch rypewdler. L IL' I)ov I <br /> UNIFORM HAZARDOUS 1.Generela ID NumberEmagancy Pmpana Phone `' 0 hill <br /> 6 4 31310 JJ K <br /> WASTE MANIFEST CAR000171645 2 77 577-2669 <br /> S.Oenae'a'a Nome end McNp Padre= OawId0rSErmAddRee Qld �ent91cnma.Ing eddrete) <br /> Rase Depot C/0 PSG III Hate Depot CSA NOME DEPOT tH115516 <br /> 5151 he Felipe HOME DEPOT tROSS76 711 OIUCT PAIINAT <br /> c T 7715 8fi61313-7341 LATHIOP CA 95331219 85a-5513 <br /> . ,0Number <br /> a.Trenpo a1 Amplany Nara CAR000164012 <br /> 21st ICEW1klY 137V ONMENTAL MANAG MM OF NEMA, LLQ <br /> 5 m <br /> U.S.EPAID Number <br /> 6, eegtabd Fedlly Nan a and Me rob <br /> 21st Century 6nviroatental Managesent at Nevada, LLC <br /> 2195 Newlands Dr. Mast <br /> Fear ,pI,,,Jarnlr , M7 89418 (775 575-2761 KVD980895338 <br /> 9b.U.S.DOT Derrapeon(Inckdhg Proper SNppbhg Name,Hexad Ckaaa•ID Number, 10.Contaham 11.Tabl 12,Unt 13.Waste Codas <br /> ga. ad Paltlng Group(»eny)) No. Typo durably Arm. <br /> HM 0111 D115 0817 <br /> t. 01951 WASTE ADONIS, FLAMMABLE 2,1 DOT-SP1284Z Wil 001 <br /> IIF 001 Q P <br /> t- D118 0135 331 <br /> 2 UP1993 WASTE FLAMMABLE LIQUIDS, 11.0.5. (ACETONE, METRTL RTMTL 0111 0135 331 <br /> 68TIl 3 TOIL (FLASHP0INT=2i.11C) 14(D111A11) 60 00/573 P <br /> X <br /> 4. <br /> X <br /> I4.SpecW Nenoleg Nsbucaane end Pddtlenal lrtbrmatlon ( S IX O <br /> (t) HO11E2.144 - ERG(126) AEROSOLS-ACC ULATIO (2) HONES-14 - ilG028 PLAMNABLE LOOSEPACI <br /> T ALI: <br /> 15. OENERATOR'SfOFFEROR'S CERTIFICATION:I real dedea tA6tNo tentenh of dYS canaipunenl ere Ally and aauntety desalhed abo're 6Y tl'°W°P°r 9h'pploana e,and ro do&",packaged' <br /> marked and kbekNplaaNed,and are fn all respada In PMW 0031 for trenspora aaadig to appkable Internal aA raaorel yerarnnlB111BI mguktlms.If export aHpreN and I am ke Iteral/ <br /> Epode,I certify that I a corneal of Uda cans4nmem mbrm to tlk brmsof tla attached EPA PckyloArogawtof Comment <br /> I caN6ytlhat Ore waao Mrimhaun statement confined N 40 CFR M 27(api l em a hags qual la(b)('l amasma4 otygonamtor)btae. <br /> C slOeeroye PdnletYrypedN e / Month y Year <br /> LCEl (�(tt� :l0(�N /� _� 02 ro fu <br /> 16.InUmarcral Shpintras ❑Import to U.S. ❑Ecpad Asn ll.S. Podofantry _ <br /> Tmmpdtar slgrabra(fa capons ony)il9rurWra(fa erpoM onry)� Darokuryl U. .: <br /> w 17.TmnapoderAcknaMedgmatofR"c ptol Malakb <br /> r" � <br /> Transporter f Pm'edfryped Name Slgnalum MonqIN Day Year <br /> G I )0 �Q <br /> =mlPdM yped Nemo N ion" pay <br /> 1G Yea <br /> 18.Dwapan, <br /> fes.Discrepancy,lnatcanon Space ❑ Quantrry Type ❑Reall ❑Pertlal Rojecdon El Full Re1e10m <br /> ManifaN Relaence Number. <br /> t llb Meal Fed U.S.EPA ID Number <br /> M fa Genxabr) <br /> U <br /> LL Fadiys Phone: all Day ear <br /> a 1&.SiprelwaolPltemato Fadlity ja Generator) <br /> Y <br /> 19.Hazardous Wash Report Maragemenl Method Causer(a.,mdoafatarardau'xaSb TeaNrent.aWosal•and rerydln9 sYeMms) a <br /> ji <br /> it <br /> tt <br /> tr <br /> 8141 �Qi B141 <br /> 20.Designated Fal 0rmer or Oreaabr.Catil otreWpl of Aarerdo I moderate covered W Me n"Weat aueptasactedIn ban lea <br /> 1nbNr Name Na N Y Yax <br /> a <br /> EPA Form 8700-22(Rev.3-05) Pteviousedltionsa reobsolell2-1, -. _ __._ . '_._ --DESIGNATEDFACIL TO DESTINATION STATE(IF REQUIRED) <br />