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820 S Cluff Ave Record ID PR0514102 <br /> 11-18-19 Program: HW <br /> PHOTO 1: <br /> Hazardous Waste Uniform Manifest not signed by the designated facility. <br /> -• 0}33 2046 sax_ <br /> '1Xl L. YSY.T <br /> v vrd <br /> waltlL FM lrM1IFM1t fR:F eCTG w E� Cl RY�1� <br /> —0— <br /> Fwll'iL F.�fl.L!!rT`t Kw'.+CFS�Y_ ;.7M111STJ <br /> i JJIi�M!M M <br /> Wp�r i�Le 4/p12T�'S G. iMy� <br /> 'rw•u....1�.r:>.r,� w�:n -.ter-to�rM r��1L, '4'-- a -ra <br /> G� <br /> ,� realermy mm aae Md rod�+enrromeuo^ <br /> ' 7D.rruMeCA'ILE+SfBL !'F Gyn r <br /> F GUN7R•i ftY' F•l.r�a E'Ir.'tt QpJr.E/!T•L - __ <br /> H/JOLEi•S SSr4L7 tt^SE'T-trre it w40 1J's'E kVI F+R J'•t7i1 PGE <br /> t5 (iHiBLpTV}p'8O�pFi♦9!!1R'S CERTiF1LATxON i nereny deCne that fie Gprrtents d this wnsgnmenl are Ildly an0 a�nua161Y destnoed atai of the tx�Per�rpV^9 ryrrr0.aLL ae aaeelAed.qu',a3ed <br /> nwkpd arra labeblgl+aardea a��:ere Mr r¢app�`m Iii W 0Aldit n Id b spuft a dn9 U'aPPhrabie m�enl�wrral9M na4onaf 9o"enenE W'e9W�Pns n eryul slr{+srnt a 41 aa�Sre Fnmarr <br /> E.ywnx I s'gy 1M the mn"al prs wrgOrc^an vxAamW am lents M dw attached EPR F Jmmvlad6menl of Cgnsan <br /> t gypsy,pre wmae nlirsrrsraeor:s,axerlsn menufrd m 40 CFR 262.21M(e I am a large quantdy generatal a it)N I am a—W q—tAy gerwr I s ince <br /> Srgnature Sknr^ Jar rear ` <br /> GemalvsrnRrtYs FnrrlrearTy(Bd Nero ` <br /> r <br /> ld1t IntnnradVla'yliMte^1s Inrpart1lo U.S ❑EePal Iron U 5 Pat d erruyleut <br /> rra�sp>ner srg^aW�1lrrr e> oMyl Date lear,m9 U.5 <br /> *7 Tran„paler.40V+olNadpmenld Rererp'.dMelanal6 <br /> Trarrspater t Frdedrryped Name Signature �-d7 .year <br /> Z Tri3rraporier2 PVrl WTYPed$q&� Signature 18onth pay <br /> 1 SE Dtsrseparrcy <br /> 16a Drsvepancy lndlc-.mn Spam Type Ll()uan�iy ❑Resrdee LlPartialRey�etgn ❑FuY Rer�sm <br /> ❑T <br /> Marulnsl Rnlerencn Number <br /> U S.EPAID NSunLer <br /> 78G Allamate Facnlrly(or Garlefawr) <br /> J <br /> L.1 <br /> LL FBoirilV S Phone VA nth Day yea <br /> �j 'Bc Signalureal Alternate FadRy fa Generalorl <br /> Ne <br /> NIS Hazardous Waste Report Management Whod Codes(I a aides for hazardous waste Irealn)enl disposal.ang o tecYOI systerunl <br /> y1 2 <br /> j 3 <br /> 0 <br /> 2a DustgnatO Fariley Uwner or OWalw CsrElhoation of reoaip(of hazardous materials covered by the mamiest eKG&pl as nded to Item lba tAanm day Veal <br /> Fnrr[edrTyprid Name <br /> SVgoatire <br /> GEt�ERAYOR'S 4N111A1 CDPY <br /> EPA Form 8700.22(Rev 12-17) PreVI0u5 editions are obsolete <br /> CLAUDIA MURO, EHS Page 1 of 2 <br />