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7,a,, 906951 94721
<br /> Please print or type.(Form designed for use on elite(12-pitch)i torr.) Form Approved,OMf3 No,2050.0039
<br /> UNIFORM HAZAR)OUS 1.Generator 10 Number 2.Pa e i of 3,Emergency Response Phone 14.Manifest IFacking Number
<br /> WASTE MANIFEST _ 004948578 JJ
<br /> 5,Generator's Name and Malting Address fus Ganerator Site Ad fess ff different then maiiing address)
<br /> BOMB DEPOT C/O 38 CORPANY HOME DEPOT JUDII06
<br /> 1905 ASTON AVENUE Me 255 CORMERCE AVB
<br /> 6,Transporter 1 Company Name U.S.c A ID Numbar
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<br /> 7.Transporter 2 Company Name U.S:EP 'u
<br /> ,. �r00000 7 red
<br /> 8.Designated FacRy Nama and Site Address is U.S.EPA ID Number
<br /> 6
<br /> BURLINGTON ENVIRONMENTAL, LLC, RENT FACILITY } I
<br /> 20245 77TR AVENUE SOUTH
<br /> Facilit s Phone; VRVT VA Q9817 [7qll
<br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Cfa§s,10 Number, 10,Containers 11.Tbtal 12,Unit 13.Waste Godes
<br /> HM and Packing Group(K any;) No. Type Quantity Wt.Not,
<br /> UN1950 WASTE AEROSOLS, FLAMMABLE, N.O.S. (MSTRYL'ETRYL KRTONBj D c)a J SBell D035 331
<br /> I �
<br /> tRR 2,1 DOT-SPI2842 RQ(D001=I05) i P .
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<br /> 0 2. UN1263 WASTE PAINT RELATED MATERIAL 3 PGII RQ{D001=100( �1�� .t �.0� D501 D035 33I
<br /> R P
<br /> 3 U112010 WASTE TOXIC, LIQUIDS, ORGANIC, N.O.S. (2,4-D) 6.1 PGII r D006 D016 331
<br /> ? 5Y
<br /> X 'TOXIC' RQ(D056=10) P
<br /> a, UN3266 WASTE CORROSIVE LIQUID, BASIC, INORGANIC, N,0-S. (SODIUR _D r -
<br /> x HYDROXIDE, POTASSIUK HYDROXIDE) S PGII RQ(D002=100)
<br /> 14.Specel Handling Instructions and Additional Information
<br /> (1) HORS2,1-03 - ERG(126) AEROSOLS (2) HOXE3-03 - ERG(128) FLARMABLB LOOSEPACK (3) HORE6.IL-03 - ERG(153) TOXIC
<br /> (LIQUIDS ONLY) (4) HOMIEB-54 - ERG(154) ALYALINSICORROSIVS LPROPOSALI: {
<br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged,
<br /> marked and lebeledfplacarded,and are in all respects in proper condition for transport amording to applicable international and national governmental reguiations.If export shipment and I am Iha Primary
<br /> Exporter,I unity that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent.
<br /> I certify that the waste minimization statement(dentlFed in 40 CFR 26227(a1(tf I am a large quantity generator)or(b)lift am a small quanthy generator)is true.
<br /> Genefalor'sttOfferoes Printedffyped Name Stgnalure Month Day Year
<br /> Ari WAY
<br /> _j 16.International Shipments ' import to U.S. El Export frons U.S. Port of ewryfexit: —�._._..._____..�.________
<br /> Transporter signature(for exports only): Date:saving U.S.:
<br /> w 17.Transporter AcknowledgmentofReeeiptofMaterta(s
<br /> it Transporter 1 Printed/Typed Name Sk}natura f Month Gay Year
<br /> 4 Transporter2 P nled/Ty Name t Signaiwe Month Day Ye 1
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<br /> 18,Discreian _ . )
<br /> 18a.Discrepancy Indication Space L_� quantity Typo L Residue l I Partial Refection J Full Ref eotion
<br /> Manifest Reference Number:
<br /> iBb.Alternate Faciffly(or Generator) U.S.EPA iD Number
<br /> U
<br /> t4 FacAl ty's Phone:
<br /> 18c,Signature of Alternator act,y or Oeneretor Month pay -year
<br /> f"
<br /> Z
<br /> N10.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems)
<br /> 3, �
<br /> 20.Des gnated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the menffest oxcep!,iits noted in item 18a
<br /> Pri,ed ype Name _ Srnature Month Day ?^
<br /> EPA Form 8700.22(Rev.3 5) Previous editions are obsolete. t E's—IG AT'E( CILITY TO CBESTINATIOft STATE(IF R EC UiRE )
<br /> DEC 29 tat+ 5::,I-145
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