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state of Colifornic,dEnvi......tal Protection Agency • �336.55�/ a 613e <br /> Form ApprovedO No.2050-0039(Expires 9.30-99) -See lfigtrUCtions OD batt( OF a 6. Department of Toxic Substances Conk <br /> Hease"prini or type. Form designed for use on elite(12-pitch ribr. Sacramento,California <br /> UNIFORM HAZARDOUS I. Generator's US EPA ID No, Manifest Document No. 2. Page I Information in the shaded ares, <br /> 5 a is not required by.Federal law. <br /> WASTE MANIFEST <br /> of <br /> 3. Generator's Name and Mailing Address A. Slate Manifest Document Number <br /> HOME DEPOT HD5676 23775289 <br /> p 1905 Aston Avenue#100 B, Stale Generator',ID <br /> 4. Generator's Phone I I Carlsbad,CA 92008 800-380-3220 <br /> N 5. Tmnsp.,N,1 Company Name 6. US EPA ID Number C. Slate Tranaportar's ID fRaserved.h <br /> h <br /> o SLATE INDUSTRIAL SERVICES T 01611141 016 ''D. T,anspa,mLs Phone <br /> 903.874.3355 <br /> T 7. Transporter 2 Company Name 8. US EPA ID Num6ar E. Slate Transporter's ID[Reserved.J, <br /> 4nJ 1 0A cmtm� �0�lF. Transport.,',Phone <br /> Q <br /> 0OU 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stale F, it to <br /> N¢ POLLUTION CONTROL INDUSTRIES <br /> LC)Z 4343 Kennedy Avenue w, fdaaiy,Phone. <br /> r1_0 East CHo"o, IN 46312 1 11 NJ R 01 01 0 18 14 16 19 14 13 219.397.395' <br /> �Q12i Containers 13. Total 14. Unit <br /> U 11. US DOT Description Jincluding Proper Shipping Name,Hazard Class,and ID Number) 12. Type 13, Total <br /> 14.Wt/Vol I. Wwsrw Number <br /> �z Waste. Flammable Liquids, n.o.s., est State <br /> 34F <br /> G <br /> (Ayiene r Toiuene), s, uiV lag"s, PGii, (ERGis i Bass' u ivi EPA/Other �:M i <br /> E <br /> stale <br /> o N act. a�2i <br /> m E ( — ' <br /> R t VI ) the <br /> 7-777.A <br /> o T sa _ est. stare <br /> m R <br /> ac <br /> w <br /> State <br /> Z est. -99: <br /> W <br /> v <br /> W <br /> h 1'. Add ip' fe r I tested Above - 't K. Handling Codas kr Wastes.Listed Above <br /> O [ V NOAVIA rECWed at alSpwa)faC <br /> H -3 3h $$pN� Ile) El-lis EJOC SHI t <br /> 11b) MAIL jh7T 11d) EIACA NOTfjH tpPL` d. <br /> a <br /> Z I5. Special Handling Instructions and Additional Information <br /> HOME DEPOT# HD6576 46104 Run 0 VYWHH <br /> Z Proposal 701 D'ARCY PARKWAY IN CASE OF EMERGENCY,CONT ACT 3E AI 8W.45i.aUS <br /> = 33101 LATHROP CA 95330 Store Contact 7F R09J 858.5513 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this eansignmenl are fully and accurate)y described above by proper ship{ring name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations, <br /> —z If I am a large quanliq generator,I certify that I have a proggrom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical <br /> a practicable and that have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human hel <br /> and the environment;OR,if I am a small quanfily generator,I have mode a good Faith effort to minimize my waste generation and select the best waste management method that is <br /> available to mss and that I can afford. <br /> O <br /> } Print pad N e Signature Month Da Year <br /> Z O <br /> W T 17, Tr s ler Acknowled ,moot of Recei 1 of Materials <br /> U R <br /> w 1 Printed/T ed Name Signa Monfhw �Day Year <br /> V t S <br /> 0 18. Trans rte,2 Acknowled a ent of Recei t of Materials <br /> / p d Name n `/�(J7 re ant Da Ye <br /> sn R Pri6 K& 1C�t da,<D n Y <br /> 1.1 19. Discrepancy Indication Space <br /> Z F <br /> — p <br /> C <br /> 20. facility fter or Operator Certificate n of receipt or haze cdous inatterisal, o e this manifest exce l as noted in Itemj9. If <br /> 5; lur 1 o Ih D0 ea <br /> r <br /> DON T WRITE BE1 T IS L E. <br /> DTSC 8022A(1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />