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2630 Tracy Boulevard PR0543710 <br /> April 9, 2019 <br /> PHOTO 2: Manifest 017087630JJK from 9/7/2017 found without a signed off copy from the destination facility. <br /> water. �`�A2p!ov¢¢.DMe <br /> t marg,n,8 F <br /> <.Man14a1 Tnohlne Nu�bxrove—Ne�2r15o-pp39 r) <br /> •�yMh 800-&7;t.y.g;, <br /> y. uenenroh I61 Atlp�y ler �I n� V <br /> 17Q; - h�M <br /> RNbrrahraPmMIC m,an�eaeroxl ` O JJ�( \No2oso <br /> 8 <br /> `` 1 trpcv.CAH,,jTWI `J\ <br /> PMiUM!{.-uat of l*97N�11174•._•, <br /> —� U.S.EPA I� D� Nry te,r <br /> —moi I I <br /> b Phpr,e, U.S.EPA I� D--- \ <br /> 1 and Ppld Gme ev <br /> ng droW(c^,da°nnylx iud - o Nome Gazam CI .IDN bar . <br /> 1.t4k-- in T sal <br /> f. 10.1-it"1f•t, Naz' TYPe ,—lity '12 U, 13.Waste CMOs <br /> A NmMh— ny l� nsln+cb'oris and Addl'6'onat lnkrmab'o�'�� <br /> DgCiirll f+ril i'Q'ir;7!--,,jr <br /> ofaet14944jBT;Q DOT ERG* �— <br /> �TO'.be FEppR�ri CERTIFICgTICN. hereby'd-l.. Intents of t—,nl are fully and acco�at5ly tlascribed ay p <br /> and'll,t at the conte,and are in all res H. <br /> r.1 certify That the canrenh of this consignment con/ormrroothe terionmsrcf Me apached EPAq know]etlgmenl of Constant]national 1t Proper sh1 <br /> Nat the <br /> waste minim¢adon statement itlentified in 40 CFR 262.27 a f am a to¢ PPIng name,am areare Gasa—d <br /> govemmenlal regulaAons.If export shipment ane-mad Primary <br /> ]taro/s Pnntee/T �� ()�f r9 quand <br /> ypee Name ��� N 9""'or)or(b)(ill am a small quantity enerator <br /> � N9 Its mle. <br /> Signature —�� <br /> at Shp'"his �— -----a'r— -_._ Monty Day Impon to U.S. <br /> mature ""0'"'Y) ❑Export frons U.S. Port cfenlry/exit: <br /> 4cknowledgment.....vreipl of MMenals— — �D=ate heaving U,S.: <br /> intedliyped N ���� � <br /> Signa <br /> nfed7Typetl �_��_L Modh Day Year <br /> Signature �� _I I 1 <br /> Month Day Year <br /> indication Spat¢ <br /> ❑Dua", o,— <br /> tiaypc <br /> Typc <br /> ❑Residue ❑penial Rejection ❑full Rejection I` <br /> 'ry(or Generator) Manifest Reference Number - <br /> U.S.EPAIDNumber <br /> N <br /> : ityate Facie � t <br /> ror�ra j�'•• L <br /> Month Day Year <br /> _ r <br /> Report ManagrNnenr Method Codes(i, ......... <br /> waste treatmentdisposal,and recycling systems) <br /> 2 3 <br /> Owner a Operator:Cerbficah of Inveretl by rhe m t as odea in Ilam]1� <br /> Month Day `leer <br /> d <br /> are obso' <br /> GENERATOR'S INITIAL COPY <br /> Lydia Baker, REHS Page 2 of 2 <br />