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Stale of California—Envimnm&rmI Protection Agency >; " <br /> to Approved OMB No.2050-0039(Expires 9-30-99) <br /> Pleoss prim or type. Form designed For use emelise(12 pili iter. $GB`IOS UffIOr15 On bOClc 0 ge 6 b.6. Department of Toxic Substances Can <br /> Sac'mmim lo,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. MahifeSt Document o. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST C L 0 0 •0 2 `'7.3 '6 7 1 2 8'r: 9 6 0 of Z is net required by Federal.law. <br /> 3. Generator's Name and Moiling Address '? A. Slate Manilesl,0ocumehhNumber, <br /> HOHE DEPOT #HD5576 '..`Ma1.1 to:'HOHE D E ePM Cj ., 242040-45 <br /> 0 701 D'ARCY PARKWAY 1965 ASTDN AVE24UE #100 B: s dle ce w om s l0. <br /> W) �4. Ge1EA'ILT•]RDPe CA 95330 CARISBAD CA 92008 <br /> QrfCm s s TVrfjtAN15PYR'TATION & d. US EPA ID Number C Stale Trans <br /> portei i ID Reserved.} - - <br /> o EMMIATION, INC. CAR 0 0 0 0 5. 2 8 0 3 `o. rranaparter>.Phane <br /> o (877)748-3040 <br /> C? <br /> .- 7. Transporter 2 Company Name <br /> 8. US EPA ID Number E' Slot*Trcmpor,ar's ID. Reserved J <br /> Q ,F Tronsporler's Phone <br /> Q V 9. Designated Facility Name and Site Address 10. US EPA ID Nvmbar -- - <br /> G. State Facility's ID <br /> Q . <br /> BURLINGTON EwIRONHEWAL, INC. KEa7T <br /> Cd 20245 77TH AVENUE SOUTH li, Facd y,Phppe <br /> N 0 <br /> �h KEW, WA 98039 <br /> ojU 11. US DOT Description(including Proper Shipoinq Name,Hazard Class,and ID Numher( 12. Containers 13. Tota <br /> Z l 14. Unit <br /> •V No. T e Oum�lliy W001 I: Waste.Number <br /> o. <br /> = RQ WASTE PAINT 1RLATRO NATSHIAL 3 UN1263 PGII INDII1) &19(128( sidle <br /> s 3 EI D MDO P EPA/Otho,D001. <br /> b <br /> m E RQ WASTE PAINT RELATED WAT88IAL 3 091263 PGII RVIIII1) R1G(128) s,me_ <br /> C- R <br /> T w 1 E D H P EPA/6 <br /> D001 <br /> oro T • State. <br /> R 3 V0'U3 D00 I – 0 1 D 1'4 1 P A/011ie <br /> aRqwnill riiI f1a I S too <br /> Z <br /> N $ 0412.6 DOO A/Olr <br /> w <br /> J. Additional Deur' tions-For Materials Li sled Above <br /> Z 'K. Handling Codes for Wastes Listed Above <br /> O a)Q. . HOIR3-1/ Di FLANNARLR LODSBPACI AF16 INC14 (7) 410][63 Id.0835.- a. <br /> w FLAN101,9 LOUSRPACI - AFI6 INC14 (8) <br /> c)�Voh�3— op �6 /uNl�t2 —SS <br /> Z M 111112 s a W),42- <br /> O 15. Spacial Handling Instructions and Additionalinformotion <br /> Z PROPOSAL#: 37659 24 HOUR MMGRNCT CONTACT: (818) 4511-8{346 <br /> w <br /> r <br /> ld. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and occuratal described above by proper ship ing name and ore classified,packed, <br /> U marked,and labeled,and are in all respects,in proper condition for transport highway according to inble inlemetional and nationaPgovemment regulations. <br /> ._ <br /> w-s' p I am o large that I generator,I certify that I have o proram in place to reduce the volume and loxic%of waste generated to the degree I have determined to be economically <br /> practicable and Poet I Isava selected Iha racticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human h*ahh <br /> m and the em,irannuml;OR,.if I am o small quantity generator,I have made a good faith effort io minimize my waste generation and select the best waste management method shat is <br /> 0 available to me and that I can afford. <br /> } Printed Typed Name jSigum <br /> Month Day year <br /> V ELVI,J F.jIbTEZ - o s <br /> W T 17. Transporter 1 Acknowled emenl of Receipt of Materials <br /> R <br /> W B Printed/Typed Name Signe <br /> III <br /> S ^ Month Day Year <br /> w p Vs <br /> LL p 18. Trans iter 2 Acknowled ement of Recei t of Materials 0211 11101 <br /> O 1 Printed/Typed Name - Month DahEyYear <br /> V R <br /> F <br /> 19. DiscrepanDiscrepancyIndication Space <br /> Z <br /> — p <br /> C <br /> L <br /> I 20. Facili Owner or O erawr Cerfificolian of receipt of hazardous materials covered this manifest except as noted in Item 19. <br /> Y Printed/Ty ed Name Si lureDa <br /> Month y Year <br /> OA, n 3 If os <br /> DO NOT WRIT FLOW THIS LINE. <br /> DISC 8022A 11/991 - .White: TSDF SENDS THIS COPY TO DTSC WFTHIN 30 DAYS. <br /> . EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />