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1505 Navy Dr, Stockton Record ID PR0517638 <br /> 4/26/2019 <br /> Photo 1: Manifest number 017144908JJK (10/19/2017)was found without a signed off copy from the destination facility. <br /> Form Apprcv"DMR NO.2050-003S <br /> Please phnt or typil" <br /> orm oast red for use an elite(12 Itch ty ewriter. <br /> 1. for <br /> ti, <br /> ID III <br /> ( 2.PaAe t of 3.Emergency Reapunea Prom 1..ManNaatT`ryecatng N-1a. CO)p 1 K <br /> UNIFORM RPOa01 [ yli© U�"WASTE MEST Generalore SltsAdamea(d OlAerenl loan matnng addreea} <br /> 5.GBnarelar5 Name entl Melling Address <br /> Genem[ars Phone: D.S.£PAID Number <br /> 6,TmmPodsr 1 Company Name <br /> N.S.EPA 10 Numhn <br /> 7.Trmlgi h r 2 Company Nems <br /> A.Dasdgr�eled FacIIIA NamB and GI1a Rddre99 11-5.EPA Io Nurr&r <br /> Facility's Phone'.'- <br /> Ah.U.S.DOT Description[WIPmPar Shipping Name.Hazard as <br /> rd G ',IG Numbs', 10,Contelnem 11.Total 12J0 13.Waste Codes <br /> Aa, and Pac4:rgG—Plil any)) Na. 7ypa Own% WWoI, <br /> HM ' <br /> s _. <br /> 0 <br /> QN <br /> K <br /> W Z <br /> W <br /> { I <br /> 4. _2 I <br /> 14,Spaalal Handling Inshunllon—c!Addlllonal 1,lomoslen <br /> 15. GENERATOR'NOFFERON'S CERTIFICATION,(hereby declare macme canteMs of this ocnsignment ora fully antl acouretely descdhed adoee by the proper shipping name,and are dasslfied,pacMaged, <br /> mal and lahslsdlpll and arein all respects N proper condltion fort—spirt aocading to appllcable latemalJonal and nalJonsl gmammental regutagosa.I€mpod shipment and lam the Pnmary <br /> Exporter,I sanity thal the contents W this consignment cnnfun to Na terms of the attadW EPAAzms vedgntent of Consent. <br /> I Will Ne waste minimiaatian elalement Identified In 40 CFR 2K.27(a)III I em a large guanfity gensW04)or(b)('dl am a small quarNty genereW@ Ia We. <br /> Ganeratoraf cors PdntedlryPad Name SlgnaMrs Monty Pay Year <br /> J 16.Irtemallanal5hipmenla <br /> ❑Impadto US, ❑Eapprtfmm U.S. Po0.ofel <br /> Z Transporter signature Ifor exports only): Date Ieaving U.S.' <br /> 17.Ymnspoder Acknowledgmentaf Recreipt OF WW6215 <br /> Yranspoder I Printed17 ed Name Signature Monlh Gay Year <br /> d <br /> a <br /> 4 Transpodar2 PnntedfTyped Name Signature Month Day Yea[ <br /> tr <br /> r <br /> SA.DNcrepancy <br /> 18a-Discrepancy mdice@on Space ❑Quantity ❑Type ❑Residua ❑partial Rejector ❑Ful!Releftn <br /> Manifest Relerence Numher: <br /> 186,Allemate Facliry(or Generator) U.S.EPA Ip Numher <br /> J <br /> U <br /> s4i Facilily's Phone: <br /> 180.Signature ofAttemale Facility loll Ganeralm} Month Day Year <br /> a <br /> x <br /> 19.Hazardous Waste Report Management Method Codas lis-.mdse roc Itazardoua cowls Oeaunant,disposal,and recycling systems) <br /> L 2. 3, 4. <br /> 20.Designated Facility 0wneror Operator Ce'O mwn of recoil nMrdaus materials Wwred by the manileslexcept asndad in Item 18a <br /> ilfl PNntetllTyped Name Signature MonIN Day ear <br /> EPA Farm 870022[Rev.305)Previoas edit are obsolete. GENERATOR'S INITIAL COPY <br /> John Alaniz, REHS Page 1 of 3 <br />