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3927 East Clark Drive PR0514138 <br /> October 10, 2019 Program: HW <br /> PHOTO 16:Waste water disposed of as non-hazardous waste with an incomplete hazardous waste determination. <br /> nhANIF1:er 'va000aesa <br /> '+ kNa Name Mal dray ZQ, ].Pego tot .Eme qR r <br /> Mhnr R4AnA <br /> / •'., ._ J.OMBNON No.205pam,. <br /> f.G or lO Numper 2.Paget at <br /> WASTE 33.Emer <br /> HAZARDOUS a"ef''t gen<y Resaon;r.Pnare . Talking Numper <br /> WASTE MANIFEST 4Weare T <br /> t„ne aloin Name and Mailino AWress Gena lois SAe A4dresa(A tlillorenl than mall,nq atldressl <br /> n-�— U.S.EPn ID Numper <br /> U.S.EPA ID Numpar <br /> 8 Designated Fsc,ly Nam.and Site Address <br /> U.S.EPA ID Numbar <br /> facili's Phone: <br /> 9.Waste Shipping Name and Deacnpticn 10.Contains, 11,Talal 12.Unit ll <br /> 1......r :IL Ah'l rlll!S c-.:',;:� i•.;,Jli.`•.JN'P.S!� No. Type OuenbM WtNU. , <br /> a J.vi 1171 i <br /> 0 <br /> u <br /> 3. <br /> 4 <br /> 13.Speval Hantlling Instructions antl Addili...I Information <br /> 14.GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully aM accuratelyabove by desonbe l aby the proper shipping name,that are classified,packagoo. III <br /> marYetl an labelediplacarded,and are in all respects in proper conddion f¢r transport amoming It applicable inlemalional"tetanal govemmental regulMWs. <br /> Generato/y0teror's Pnnt typed Name Sigreture Month Day Yea, <br /> 11 <br /> 15.Intemational shipment <br /> ❑Impod to U.S. ❑Export Irom U.S. Purl of anvylexa: <br /> = Trans oAerS nature for ex ons onl Dale l¢avin U.S.: <br /> ac 16.Transporter Acknowlecigmenl of Receipt of Mah tals <br /> Transporter l PnmedrTyped Name S'lgneNre M."', Dal Year <br /> i <br /> RTranspoAer"n Name Signature Month Dav e <br /> t— <br /> 17 Do"N"Y <br /> Ila.Discrepancy lydl d.h Space y ❑Type ❑RoU&a ❑ i ❑Fell Rare,— <br /> ❑Ouanlil Pallial Re action <br /> Manifest Reference Number', <br /> 17o.Areh ale Facll4y for Generator] U.S.EPA ID Numper <br /> U <br /> LL Fachiry's Phone' <br /> w 17c.Signature of Ahe,Msa Fanlry for Generator) Month Day year <br /> at <br /> ro <br /> D <br /> l18 Designated Fazd ty ONner or Operator CeNf aeon of nshelpt of materials wvered by the manifest except as wled Ilam 17a <br /> PnmedTypM Name Sight; Month D.Y Yeah <br /> 169-OLC-O 17977(qeM.9/09) GENERATOR'S/SHIPPER'S INITIAL COPY <br /> Lydia Baker, REHS Page 16 of 54 <br />