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250 E. Roth Rd. Record ID# PR0527662 <br /> 10/20/2020 Program: HW <br /> Photo 1: Following uniform hazardous waste manifest (021239191JJK), lacking signed designated facility copy. <br /> Pleas,pini a ke' <br /> IlN6ORY xAZAR�pIrS r aar�ak.roNimBer 2 Pqa r a ] Fath ved.OlAB No.2ne�9 <br /> TE <br /> bC �GY.YJ�1yk47 q��-y 021 239 9 .ISK 9039 <br /> �a'�Sc3-49Q0 ��fL1�p G!4 6-3.307 <br /> e.rravPaax 1 ra„P,r xaaw U S.ePa to N„me., <br /> Geary.W Lo—Y.Ina CARr�pa0AT019 <br /> rasP .rzcaw.r �LI� T:74I.T-q_� usEwloNm�a <br /> 1217 S.FIESTA Ave. E A.7.R000EtEt E1 <br /> PARKER.AR 983AA <br /> Fe Phone'76691 •247 <br /> Ba, ab.L.N.OaTdaaolpeoi(hoyal,v P,9om SNPPIna Name.Marmtl Clem,to N—, Se.CanlaNen 11_dal 12.1fn0. <br /> HM ane Pachmg GnalF prenyl) rf9. Type Geanaly VVLN.i 13-wattle c�¢es <br /> o x1' MON RCNA HAZERDOLIS WASTE SOLID (paper&plasilc ol1 filters) 1 Gti1 P 35_• <br /> � r <br /> 7. <br /> 4. <br /> {/�• 4,Bi—1 Na ftq ftln bons and Pddifi—I Wo,mal <br /> ERGq:f 70 Paper&plaadic oll 1111erai <br /> USE GLOVES IRIVr3lCEii <br /> F'ronle#D/Qj�r O�OJ^�J� <br /> un�saJra .4��x(Fi�f 40--t,qs-� <br /> 15. SENERATOR'SIOFFERORS CERr)F1CATrON:I hereby declare Nat ft contents of this consignment are filly and accurately descd4ed above b'l the proper SNpping name,and are dasffif�ed,packaged, <br /> marked and Iabeledlplacarded,and are in all respects 1p proper condeion for transport according f applicable himmatl_and na4onal governmental regulatlonx.If export shipment and l am eve Primary <br /> ErporLv,I cerafy that the contents of this eomlgnment aordolm to ale[arms orf.attached EPAAcknoxladgment at Consent. <br /> 1 corery that the waste mloimieeaon statement ldendyied in 40 CFR 262.27(x)If 1 am a large cI anety generator}or(b)(ill am a small quantity genera"is true. <br /> GeneratorslOaemfS Pnn yp me Signature Month Uay Year <br /> IsArld—lional shipments <br /> p_ Import to Us. ❑Export from u 9. Pon of eflbyloedt <br /> ? Transporter signadae{/or expor+sordyJ: Date leaving U.S.: <br /> 17.TrdnsporWAclmowledgmenf afReoelpt of Wail � <br /> Transporter l Prim yged Njr a a Signature Month ❑av Year <br /> o M b` <br /> a <br /> T pwler2Prinled7yped Name <br /> -N—U I <br /> Signa e Monf Uay Year <br /> 1[ 18,Discrepancy <br /> lea.Discrepancy lndicaaon Space ❑Ovair ly ❑Type ❑Residue ❑Partial Relecilm ❑Full Rejection <br /> Mal Reference Nbmhec } <br /> rr- 18b.Nlemate l{or Generalor) - US EPA Io Nur lbel <br /> J <br /> U <br /> Q <br /> LL Facility's Phone: <br /> u IHc,Signalure o(Allemate,Fal(or Ganerater) Moil gay Year <br /> Q <br /> Z <br /> - 19.Hazardous Wattle Repod Managemenl Method Codes{i,e.,codes for hazardous waste Veall disposal,and recycling systema) <br /> 2. 8. 4. <br /> 211,Designated Fal Owner or Goal of receigl of hazardous Mal covered by the mal except as oiled In Item 18a <br /> PrrnledlTyped Name Signature Month qay Year <br /> EPA For n&7D0-22(Rev,12-7)Previous edit l are obsolete. DESIGNATED FACILITY TO EPA's la7MANIf EST SYSTEM <br /> JASON GAITAN, EHS Page 1 of 25 <br />