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Slots of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of a 6. <br /> Please print or type. Form designed for use out elite(12-pirch ricer. Deportment of Toxic Substances Cons <br /> Sacromento,California <br /> EGenerator'3 <br /> ARDOUS GenerOlar's U8 EPA ID No. Manifest Document No. 2. Page 1 Formation in the shaded a eat <br /> NIFEST CAL000273871 (] 5 8 a of 2 not required 6y Federal law. <br /> Mailing Address HOME DEPOT A. stale Manifa,r:Documen t Number <br /> l�°r�5DSCI, "69891100800-300-3220 23620580 <br /> � B:Slats'Gedetutor's ID <br /> f\ ) - - <br /> h 5$LAJI8'IW0LMTftL SERVICES 6. USE ��51488 C. Slate Transporter'.ID Reserved] <br /> T 903:874.3391 <br /> pD.Trodsporleds Phone - - - <br /> °D 7. Transporter 2 Company Name - <br /> P° fa Y 8. US EPA ID Number �E Stare Transports s ID[Res._sued:] - - <br /> J <br /> Q F` Transporler.'s Phone <br /> OOV 9. blgt gN hDOWMeOcINDUSTRIES 10. US EPA ID Number G.Stat.Facilily's7D <br /> D:Q 4343 Kennedy Avenue <br /> �� INDOOOB48943 <br /> C�..i f^L.;e.�,.n INI ARO40 H. <br /> Faun Phone - <br /> C\ a r-aas."nsu�ap, ne vsso tr. N's. 219.397:3901 <br /> C9� <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Container, 13. Total 14. Unit - <br /> No. Ty a Quantity '.V;/Vol H: Wbsle.Number <br /> �= X ° (RQ=1000), Waste Flammable Liquids, n.o.s., 3, UN1993 stab <br /> 3 G PGII, (Xylene/Toluene) (ERGf#128) � DM G <br /> ,ki E <br /> O N <br /> E State <br /> < R (fteizil 10111 <br /> 11011) 15rA <br /> o T <br /> 0 state. <br /> R ) U EPA/Ot6er —OtL1E <br /> Z X d Non-RCRA, Hazardous Waste Liquid 'sate 291 <br /> LU ' DM <br /> V G EPA/Olh{c <br /> H 'J Additional Descriptions'-for Materials.Listed b NN <br /> mri 214 <br /> 0 - K Noodling Coda for Wmses Listed Above <br /> 1 11a) EI-3 ('7 x 551�M J 11c)' EI-11S N OTS H 11PsPE IS 'a. O j. 6. <br /> 11b) EI-71L NOT 6.1* 1 J-1-6b 11d) EI-1CA ( I x 55DM� l <br /> c.'3 <br /> dr.�9 b <br /> Z 15. Special Handling Instructions and Additional Information <br /> Run I WWEE <br /> Z HOME DEPOT/HD5576 701 D'ARCY PARKWAY IN CASE OF EMERGENCY,CONTACT 3E AT 8M.451.8346 <br /> w Proposal @ 31377 LATHROP CA 95330 stare Contact Yi <br /> . x <br /> 16, GENERATOR'S CERTIFICATION: I hereby declare that she conlents of this..nsi8;marl are fully and accurately described above by proper skipring name and are classified,packed, <br /> U marked,and la6ded,and are in all respects in proper condition For transport by highway according to app lic°61e international and nation*Pgovernment regulations. <br /> IF <br /> I am a krge <br /> Eli generator,I certify that I have o progrom in place to reduce the volume and toxicity of waste generated to the degree I ham determined to be econamicallr <br /> practicable and!at, <br /> Ihot I hham selected the practicable method oft treatment,storage,or disposal currently available to me which minimizes the present and fuwre threat to human health <br /> and 180-anWonmenY;OR,if t am a small quantity generator,1 have made o good Faith effort to minimize my waste generation and select the best waste management method that is <br /> W available to me and that I con afford. <br /> ZPrinted/Typed Nam ` Signa ` Month Day Year <br /> W !� 7 D <br /> IV I 17. runs oder I Acknowled ement of Recei t of Malerials <br /> re R <br /> W . t /Typed N m Si re Month Day Yeo <br /> W P rti t�rc� uti a- I o <br /> Od Ie. Trans aer 2 Ackmw ed emenl of Receipt of Materials <br /> w <br /> F Printed/Typed Name Signature Month Day Year <br /> QR <br /> V , <br /> 19. Discrepancy Indication Space ter •- <br /> z A epafJL.T I SGS ��M�cv. t �aio�( Cf��oo�a�zEs'1 <br /> C 0-o1rl Bo\> <br /> i NPr' i�►.� pi,� U0- '3 6S�1 `��=L3yt <br /> 1 20. cili wner or O er Ior Cedificalion of receipt OF hazardous materials co ered is manifest ce f k Ile.19. <br /> T Prince / P Si a MOMIy� Do Ye <br /> Y U <br /> DO NOT WRITE BELOW T I LINE. <br /> DTSC 8022A (1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 870D-22 To: P.O. Be. 3000, Sacramento, CA 95812 <br /> MW IM <br /> vs.:u.dt"s3fr;�.:-:-•sem: 0-N fid:",.i.;w-IMP,,. <br />