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601 Darcy Pkwy. Record ID# PR0528650 <br /> 10/26/2020 Program: HW <br /> Photo 1: The following uniform hazardous waste manifest (020351004JJK) observed lacking designated facility copy. <br /> Form Approved,OMB Na.2050'0039 <br /> d-GeneratorIDlft,er2.P�eld a.Emeigency,ReaponsePhone A M,MW 7-Ang Wsrber aJJK <br /> C A L Q,,,4 0 4 2 e4 a 1 7 1 800824-9136 <br /> 1ftWMffibHT LINE INC. <br /> OLD DOMINION WAY 601 DARCY PARKWAY <br /> THOMAS ILLE NC 27360 LATHROP CA 96330 <br /> General NPhonB. 3 3 6 8 2 2 6 7 6 0 us EPAIONumue* <br /> 6 'Mi �a(menta{Servlc-m CAP 0 5 9 8 8 8 7 ® 4 <br /> 7.Transporter2 Company Name US.EFAIO Numhar <br /> V.S.EPA ID Nnmbef <br /> 1830 WEST 17TH STREET <br /> LONG BEACH C4 90813 CAD 0 2 8 4 0 9 0 1 9 f' <br /> Faoli's Phone aW a27-8729f <br /> 1e.Containers 11,TT9V 12.dni4 13.Y+astn Godes <br /> 90' 9b.H.5.N97 Dearnpli0n(In[W911g Proper Skipping Name,Haaard Clasa.ID Number, No Type ouanm9 W1.NM <br /> HM and Packing C—p(M anyi) ,�I <br /> Slvx�s�k► uk L+'�C ki �� iiG �'L P <br /> 0 <br /> 35Z 1�j <br /> W 21�u k A i(E�nCt1 xt 3 L,;c,S`r :;:>lt I ��� V-),F: M�J <br /> X 3.(�IJy��lx�St �JSSSr cl,tl,,,n1�1�.12'� - <br /> SS I <br /> 3E715�{ -19) 11 J <br /> ,a sHjesxAocHlral ea B I <br /> i; "• �'� Nan y h name,and are rj.rpf,.d,pada$ed• <br /> menlat regidaM1pns.1E erpnrt shipment and l am the Ynmary <br /> U <br /> 15 marNe GENSRATUR-W-11 <br /> abaledlpEacaU led Anda elCAaloepects inpmPe—naionfa�aanspodajollsolthl�rdin99m aPPl aUa�mlemaiiaalslndnatiwal goue�ve by Ne gaper%IP➢+n9 T. q <br /> ti <br /> Exporter.(ceRiry that the contents of Nis consgmnentoonkrm la the terms of the adadied EPAA�n ewlemlor}a(b U aorta small-,bty Saneratol)s,Into Year <br /> ([edify that the waste min'nlszauon stalamentiden ed in OCFR26227ta)(dlam alarge quantity$n -- Irbnlh Day— 2 <br /> SaEure h <br /> H I: <br /> G.y,,omtorslUHeror Pdnle�Ped me ) ,`Lr. r I { q r <br /> W 11111 r r 11 PllaolentrylasC <br /> I6.Intematonat Shlpmenls []Impom to U 5. ❑EKpon lrem U.5 <br /> Date IeavNg U.S.: <br /> 7ransporlar signature)fa espods ally) Year <br /> of of Mllertal% blollth Day _ <br /> � 17.7rensyoderAdalowled0mant Recei p' Signatwe 1�i Epq Fn <br /> Transpoher I PdnteMYpod Name <br /> A.Irf L hteno Day year <br /> a Signalare <br /> Transpolar 2 Pdnledayped Name J <br /> 1a.Discrepancy ❑Residue LJPan+al Relecllon El F.11 Relecuon <br /> 15 oieaepanay Irdlcatlon Space puanldy ❑7yPa <br /> Manifest Reference Numdel ll,S.LWD%mher <br /> 18b.Alternate radfdy(or Generator) <br /> J <br /> 4y Month Day Yaar <br /> u0'. Facitiys Phone'. <br /> � Idc.Signature olAllemate Facility(or GaneFalor) <br /> 4 <br /> = h <br /> LD .9.Halardoas Waste Repot Pdanagemenl Method Cedes(l.a.,codas forharardous waste UOamlenS,dlsOjsal,and recycllrrg syamms <br /> w 2 <br /> � I <br /> M; <br /> Month Day year <br /> 20_Designated Facilly0wnera Operator:CeliUcatipnol reae+pl of haaatdocs matsnals covered by�am$ignalurecepr as n0ed in Item 1 a ^F <br /> PdnledTyped Name .. Is j <br /> GENERATOR'S INITIAL COPY <br /> EPA Form B7D0.221Re¢12-17)Previous editions are Obsolete. <br /> JASON GAITAN, EHS Page 1 of 8 <br />