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J. <br /> 789782 D T S C: G a 2 8 s. "J 734e49 <br /> 'Please pdrit or type.(Foml,designed for use on elite(12-pitch)typewriter.) ? Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS ,1.Generator ID Number 2.Page 1 6f 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST X232181 N� (860) 567-745 0 019 5 317 6 JJ K <br /> 5.Generator's Name and Mailing Address Generators Site Address(8 different than mailing address) <br /> Target 60319, Target 00313 <br /> 4701 Parotic Ave- '4707 Pacific Ave Attn: Photo Lab Ba <br /> GeneratoaWman CA 15107 (209)476-8081 StOC6toa CA 95207 109)476-8081 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 21st C. RIM EM Cm68o164012 <br /> er2 Company Name U.S.EPA ID Number <br /> o C E12_ E_ IYn )t 0(::) Z�-7 Z <br /> 8.Oesignated Facility Name and Site Address U.S.EPA ID Number <br /> BURLINGTON Sl99IROMML, INC. = FACILITY <br /> 10245 77TH AVEUU SOUTH <br /> Facili sPhone: RET, BA 98032 (253( 872-8030 1 T>1AM91281767 <br /> ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(i1 any)) No. Type Quantity Wtivol. <br /> 1X ' UASTB CORROSI99 LIQUIDS, N.O.S. (SULFURIC ACID, POTASSIUU 0002 122 791 <br /> r X HYDRO%IDH) 8 U111766 PGII URG(154) DF I O P <br /> z 2. <br /> w <br /> 3. <br /> 4 _ <br /> 14.Special Handling Instructions and Additional Information <br /> (1) KOBAKEKNICIA-00 - PLASTIC COUTAIMS(OW FROM PP3 <br /> 15. GENERATOR'SIOFFEROR'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 /> r4 marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached.EPAAtkrwwledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generetors(Offerors Printedlryped Name Signature Month Day Year <br /> of <br /> 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W '17 Tran porter Acknowledgment of Receipt of Materials <br /> P_ T 1 Pnnte6Typed Name Si a Month Day Year <br /> Z Transporter 2 Printedirryped Name 5 ature/ Month Day Year <br /> Zf <br /> 0 71 a <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Typej <br /> ❑Residue Partial Rejection ElFull Resection <br /> Manifest Reference Number <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> s LL. Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste ReportManagement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. 3. 4. <br /> 1 <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by cine manifest except as noted In Itam 18a <br /> NntedlTyped Name (/ 0 / Si/gnnaature lnJ Month Day Year <br /> kl) <br /> 12 71 <br /> EPA Forth 8700-22(Rev.3.05)-Previotis ediGoru areobsolete. DESIGNATED�A STATE OF REOUI ) <br /> J 10331.0986 <br />