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E. 41h St. Record ID# PR0514018 <br /> 9/2/2020 Program: HW <br /> Photo 20: The following uniform hazardous waste manifest(000336573DAT) observed lacking a signed copy from designated facility. <br /> dl rg flier neared - UYrrA57E +1R901 r do'ID la,rrhr F—A ed OMB rvo 2oM16n79 <br /> �tlies W'pr9�anuNes sc�nera�NANIPE3T t=Abg87431956 r.�0°°'a a �frr�er,..Fl� <br /> 'a+easWlaW Psion. n mesa Ay�'4„�- s Isn I ro z a�D-6338253`00 0 3 6 5 7 3 DAT <br /> �pla8le as smatea r ,�,e¢�y��r bl ren Ctsn d�mamraeunnmd.�eem�l <br /> Ore <br /> fbefo r��arard "22 Eael FOUM St <br /> wJ rarinir of c.r�nsA°ie' �AwrvrwnegG/37 RIVPrl,GA9S>66 <br /> 15511X1 rSaaimenlo dS-FPAIDNumber <br /> J/ 7rranepn,rpr2C-W,,Y Nnia N"«ErZI Pr'rOr+rE_C-Uet lbq 8768-G604""1 C-P000119iA <br /> rn / <br /> e. r..'.rnum fM1W�a V—ERI P-)NE-Cuat IDM 57,M_0002._.) U.S ern to NmeaCIO <br /> dsJ, IJ G F ry � � CARGh7914, <br /> c0r \"S <br /> e ' N14�1e� V.s.EPAlo Number <br /> Ported for weyyIV very aRy.rVV 89CO-3 Sof Beaty rJVf?3OQ1Or>;)0 <br /> P.W Phar»_ x-239-3943 <br /> n I�nthiied i !9M and 907 ogyp4tion{ak .g rnp Sh,ppng Name.lla:ad C.,to Nunbor, <br /> fared yt in Parbrrg Gmup(darrvll ro!'.cntamm 11 Taal 12.Ul to-waste Cosoa <br /> gym. ere a DE 1 NA3077,Heuer Na Pyne QranaN NAPM. <br /> es of <br /> the 9 AOT ERCaM 171 <br /> waste,6did,nO.s.(arsenic,(firom E7,!) In 13004 1)007 181 <br /> w <br /> Inery ' 8 2. <br /> sore I <br /> es,bar <br /> rarer <br /> lirdl f}// <br /> rentfred <br /> Parwhfol, s` t 4 111ri3O= <br /> Y Tlll G 9 s6 6 lY,R07, <br /> ,f <br /> P / Mill CM <br /> equlr9d r� 14 specrel Flendlirrg lnsVucbons and Addiaanai lniomrelion D705rt78 u0206285 <br /> yon in ' 1 t 07012l700!3 <br /> igv� <br /> f-'onaar.?:�r,, dc�y n,ri eratnr cgekre agestywtllorl it l trsneportill add crsuhstibele addSanletlransPOrtem on gansmiom beh7lft. <br /> 15. GEIVERATOR'S/oFFEROR'S CERTIFICATION:I hereby declare Ilial dre mrrtanis MMw cons nmeM are coil rad acaaki desmbetl shave the X1511 U <br /> r1 J <br /> "'kedand ybeledrplacarded,end are in all res N y a 7 by preps%p9lrg name,atd are dassifiad,pedage4 <br /> 1} peas in-r—corldilion for trarrspon according m appLeahlc interneuonalandnational gavemmental U g>t3aMns,It export shpmeM end 1 am 11te Pnnery <br /> 6P6rter.f ceriiiy that the cements of this oensignment conform 10 0ie leans urthe etl�hed EPgAcWwwEedgmeni of Certsant. MA7 C <br /> lcermy Ilial fhe waste mirrrmizatien slalemenl i�ntified in 40 CFR 262 27{a)(0I em a large quantity generator}or{h}(rtl em a smallquantity generaVwl is Ove. <br /> Ge""s. r-Mffemr's Fu Uedfryped Name Sgnatara Montlr Day Year <br /> rhe 061 <br /> b � <br /> 16.Harrtab—1 Shipments <br /> Z ❑import to U-S. ❑ 11 <br /> Expod ham U 5 Port a,enbylexil; <br /> Transporter signature(for aspads only): <br /> Date leaving U.S.: <br /> a 17.TranspofterAdnrowledgmene orReceipl ofMofenals <br /> of <br /> iransperler i PrintedlTypad Name Signalcae Monyn Day <br /> CL 'leer <br /> ) <br /> V) Trenspoder 2 Pnre yped Mama sgnatum Month Day Year <br /> 18�isrrepency <br /> lee.Discrepancy Incirwhon Space Ouanisly ❑Type ❑Residue ❑Partial Rejacuon ❑Full itejecoon <br /> Manifest Relenenca Number <br /> }Bh.Altemafe Fapllty(or Ganerafor) U.S.EPAID NumUet <br /> J <br /> I r U <br /> �r f LL Facdily7s Phone: <br /> r y I 3 Iec Signature oFNlemale Facilrty(or Generator) Month 9ey Year <br /> fl}�■ X <br /> TTTIII � 1 rJ Hazardous Waste Aepad Management Method Codes{I e.modes for hazardous wesle treeUnenl,dlspwal,end racyding systems} <br /> 11 1 2 7 4 <br /> 10 Deergnaled Faciidy Cwnerorfiperaloc Certifloakri of recaipi of hazardous materials covered by the manifest except as noted in Item 1 Be <br /> PnnfedlrypedName Signature Month Day Year <br /> EPA Form 870022(Rev.12-17) Previous editions are obsolete. GENERATOR'S 1NIT1AL COPY <br /> JASON GAITAN, EHS Page 20 of 38 <br />