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7679 Longe Street PR0537564 <br /> December 28, 2018 <br /> PHOTO 20: Manifest 015895866JJK observed without a desi Hated facilit si nod off copy. <br /> „nl designed far use on elite 112-pitch)lypewdler) Form Approved.OMB No.20500039 <br /> PNa"a Print or ly Generator lO Nu mbar 2Page lof J.Emergency Response Phone O.Manilas(Treaking Number <br /> UNIFORMN ES17 JJK <br /> WASTE w;encMailingAddress GenemtofsSlleAddreaegro,ferenithenmefloo,ad—) <br /> S.Genera. <br /> IJ <br /> Genr;:,l Name I US.EPAID Numban� <br /> er I <br /> ,rr„aw <br /> not Name U.S.EPA IO Numb <br /> syeal —,Facility Name and Sire Address U.S.EPA ID Nu X <br /> FaaliNs Phone: �. <br /> 9s US.DOT Deacn'p-(mcludog Proper shipping Name,li—Class.ID Number, 10.C.Imeem1 <br /> 9a. and N,k,rg GroupofsIyh ,mrttry 12.Unit 13.Waste C<Mes <br /> HM No. Type QQuantity W1 Not. <br /> W <br /> G <br /> w 2 <br /> s. <br /> a. <br /> N.Spedal HaMlvg lnsWeeons and Aadiuonal lnlorm s h, <br /> PROFILE C=.ci .5;12 <br /> T. <br /> IS GENERATtlOR'sIOFFERS CERTIFICATION In byd lM1tth tem fN'w g 1 NIIVsod accurately described a bI—bylhe prooersh'pprtg name and mee-A. <br /> IXManreWbeNNplawRCtl tl d II Is—'s Proper dti f a p d rd gt ppl'N llemalonaland nafonal packaged, <br /> ENod¢rl rely(hal the nlenls of the wnsg enr ron(orm totheterms of theadached EPAAhmeJshhmnntof Consent. 9ovemmental regulaAons if ex{ort shpment and lam Ne Fnmary <br /> ICllify halthoesste min miz tion sralement idsrffurl m d0 CFR 262.21(x)(i!am s Imge quantity generates)or(b)(al am a small guantily generab0 is true. <br /> 0e"aralMarOMel Ms Qnntedffypetl Name stun tre <br /> Month Day Year <br /> 161nkmaeenal� mpod to U.S I - <br /> ❑I ❑ExpM from U.S. Pod of enbylexit'. _ <br /> '2nspanersignalure(br exports only): Oale leaving U.S.: <br /> w 1,'.iransponer Acknm/gdgment of Receiplof Matedals <br /> Cinnsppnsrt PnnledRYped Name Signature <br /> Month I <br /> TmmPonar 2pdnleyTyped Name <br /> Signature, Monty <br /> 1 16 O acrepanc— � <br /> lea.Discrepanry meicabori spal:e <br /> ❑0uanary ❑Type ❑Residue ❑PaNal Rele-m <br /> ❑Full <br /> 1Bb.Alfernale— Facil (es Opnaralor) Mani fest Reference Number. <br /> EPA ID Number <br /> LL FaciliVs Phone' <br /> flac.SVnalure ofAtemats Faciligr(or Generator) <br /> Z Month <br /> W19.Hazardous Waste Repwl Mamtgement MalApd Copas(e rgdas to than rWs �� <br /> 1 �� waste IreaMent,disposal,al relycling system) <br /> C 2' ��� <br /> 11U.Desipnaled Fadliry0xneror OFemsor Cealebnofrecelpl ofhazaN re , <br /> -- <br /> `11 PdmPdrrypedName red by the manAest except es npep in llem jaa —��— <br /> Slg <br /> Monlh <br /> AFarm 870021(Rev.3-05)Previous editions are obsolete. <br /> GEIVE—RAT—nR�c _ <br /> Lydia Baker, REHS Page 20 of 21 <br />