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1 w 740 T 6 ® 33 <br /> 945093 Form dlipl�No.2�0-0839 <br /> Pieese` n1 or . Form des ned for Ilse on etlte(121)Rch titer. <br /> UNIFORM HAZARDOUS 1.Generator ID Num 2.Page 1 of 3. mergency Piano an t tae ng r <br /> WASTE MANIFEST0 0 5 516 6.2 5. JJ <br /> 6.Generator's ame and tleaItrkgAddreas �S sea( ram Maung address) <br /> Bone Depot C/O PSC AM. Home Depot CSR BONE DEPOT #HU1116 <br /> 5151 Stn Felipe S! CONil1iRCE AVE <br /> 21AM CA 95336"e" <br /> Transporter 1 ante A 10 Number <br /> 7. raropdxter 2 Cory <br /> 8-97VNwnbw <br /> 8.Designated fly Nemo and StaAddress U.S.EPAID Number. <br /> BURLINGTON W1101101TAL, LLC. FEAT FACILITY <br /> 21245 Im AVENUE SOUR 17R1-797 <br /> FOCI s Plmna91132 12521 <br /> Its. 9b.U.S.DOT Deaoiptbn(Including Proper Shipptrrg Name,Nereid Crass,ID Number, 10.Containers 11.Tmai 12.Until 13.Waste Codes <br /> HM and Pawn9 Group(If am) No. Type own" WtNd. <br /> Ali C <br /> 2-M1263 WASTE PAINT RELATED MATERIAL 3 Per RQ(DIIi-111) P11 ;135331 <br /> � Q 411.!� P <br /> J,0-3•UN2811 WASTE 40xIC, LIQUIDS, ORGANIC, N.O,S. (2,4-0) 6.1 POII 116 1I6 331 <br /> "Toxic, RQ(0416=11) &0 BWP <br /> N <br /> IF t <br /> 4.83266 WASTE CORROSIVE LIQUID, BASIC, INORGANIC, 1.0.3. (SODIUM 112 122 <br /> — Q —-BYORORIDE, POTASSION MROxIDE) 8 FGII RQ(0112a181) o a j B 0 01 <br /> P — <br /> -t,., 14.SpeaalHardlhrgl budononsa Addidondimmmetion IXS IXs' <br /> L , VF( (2) 8093-13 - ERG(128) FLAKKAAL9 LO031FAcT (3) EOWE6.IL-14 ERG(1531 <br /> T01IC (LIQUIDS ONLY) (4) UD EBB-15 - E19(154) ALKALINE/COUOIIVE LPROPOSAM; <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICAT10N: I hereby declare that the contents of(his consignment are fully and accurately described above by the proper shipping name,afd ata classified,Pachageo, <br /> marked and lobe seamed,and are In all respects in proper condition for transport acoording to appiic"international and rational govemmental regulations.If export shipment and IBM the Primary <br /> Exporter,I cm*Nnt tike contents of this consignment the terms d the attacked EPAAclow"Ornant d CrmseK <br /> Deft I De waste drdrdmaduion t iderr' 40 78 262.27(a)of 1 am a large quantity genera)or(b)(if I am a small quantity gdakarator)Is tine. <br /> MorNh Day Year <br /> G r rtPrakk6sd/fyped 3 09 <br /> lar <br /> at shlipmenh; ❑Import o U.S. Export from 118. Pat of entrylext: <br /> signet-(for extorts orrly): IMo leaving U.S.: <br /> w 1 Tra AdmWedg,rrentofRsaiptofMatedals <br /> Tra ,P yped Nacre Sigrahrre Month Day Year <br /> a NA N 5 03 31 a <br /> MtPrint yped Nam Signatrl Mon D Year <br /> ena <br /> 10.Discreoncy <br /> IS&Discrepancy Indication Space El Quaff ❑Type ❑Rupe ❑P Rejection �Fut ReJecton <br /> MaWW Reference Number: <br /> 10,Alternate Fadtty(o(Goverstor) US.EPA ID Number <br /> rr <br /> If Fadttys Phoma: <br /> lac.Signature if A—W ate Fad My(or ;orator) Month Dey Yea <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycIlM sysiems) <br /> � 1 H141 2 8141 E141 <br /> 120.2!,"Facility Owner or Operator:Certification of receipt d hazardous materials covered by the manifest except flf6eol In Item les <br /> Pri me watt y ear <br /> W—A I <br /> - <br /> EPA Form 070 (Rev.3.05) Pneviaps ns are obsolete. p I NNq A ITY TO DESTINAT TATE(IF RECZ IFtED) <br /> fAa OPI? 18 own:0' <br />