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601 Darcy Pkwy. Record ID# PR0528650 <br /> 10/26/2020 Program: HW <br /> Photo 2: The following uniform_hazardous waste manifest (020350666JJK) observed lacking designated facility copy. <br /> Alease pnnt or type. Form Approved.OMR No.20 0-0 <br /> F 1.Generaau lP Number d.MangeatTmching Number ��� <br /> UNIFORM XAZ,gR000G Z-Page r d 7 Eme nny es set hq <br /> WASTE MANIFEST' C Al L 0 0 0 4 2 4 8 1 7 1 8tl0 � <br /> ' bIll: 7 L1NE INC. ' rl ��:� I . <br /> 600 OLA nOMINION WAY 801 pggC1(pARI(WAY 7 <br /> ——— THOMASIIILLE NC 27360 LATNROY CA 85334 <br /> GMmabrs anene: 3 3 8 8 2 2 6 7 6 0 <br /> P ui m a, <br /> r.�s' Ofliyar�n mental Services D EAA uN a 6 3 a a 9 7 9 4 <br /> Tmnapoder2 company Name U.S.EPA IU Number <br /> se° ' �*v tlress U.S.EPA 10 Number -a <br /> _ 1930 WEST 17TH STREET <br /> LONG BEACH CA 90813 f <br /> - FapiptYePhorg 8W 827-8728 C A G 0 2 8 4 0 9 0 1 9 I r <br /> I i <br /> 9a. 9b.U 5.DOT D—nFen(mdAmg Proper Shppmg Name.Hared class,iD NumbM. 10.Uncal, 11.TWaI 12,Uni, 13-Waste Codes <br /> a HM and Padlrg Gmup(Ilane)1 y� Type OuanVty WLNaI, - <br /> ob 11114^^LL 7I.Ue1: �1tnl Qt,1 Yr1 lk1n�(YI;.d21FYl4t ��` �� P t,�`I w i <br /> 0 <br /> 4ti 2A1 ,NZ-t. r..., --� ?jr <br /> �" <br /> 3.�J1.:1.t�Y HphlYCl]i.1]WC�Y 1 !r3 la/ (ajl <br /> �: Ih.r�cwnx So-1 }� <br /> I <br /> (AUW� 1 [1 C+�4 1 lt1yY{ a ri 2�JSa�.1 �0 D� l -I <br /> fl(-[ll (Lckr.;�nCk� C7 <br /> 141'1 19- IIE, 792a CR4Bi9,CAd880 90365 3)LP55440-IFJbTA(1CHEM POp 1� <br /> 1)1 1 5.3 3,V��SZ3 { Ge, <br /> to <br /> 15. GENERATOR'SICFFEROR'SLERTIFN:AfIDN:Ihe2hy deGare that the contents of this eunsignmentars fpuy and accurately Oescntea above by dre proper shipping name.ab ora dassaied.packaged. T <br /> marked andl-Ay thalJ aberneds 11m,belrespecLS In pwperc Meemmsdthepoadhed Emgteappltlmg,mlemadonatana nalioruEgovemmenul regulaeans.Nexport shpmeM arrdtam lh.e Pnmay <br /> }I Exporter,icertity fhallha caMenls of Nis wrsignmenl ruribrmwtl�u tsrmsdthe saadled EPAAckruwletlgmenl of CaramL <br /> IraI Iyt,.t Lhe.b;I mimmrra9an daeemenl idenfifiedin4001`112622701111amalerge quantity generdlorjar(4j(111 ama small quandry generated is true, �^ T� <br /> GemeraloyslOp mes Prime ayped Name SignetufpAlp L, Day Yea* <br /> _r ifi Inlgrtl�dhW$hi es- �Impod to U.S. ' <br /> z Trans ❑Eapon fmm U.S. Pod of entryle4k <br /> pd"uler slgnsWra�[olexpods enlYl: 001e INU.S,. <br /> af7,TranspwlerAchnowledgmanl of RerciptMhylsAals <br /> Transpgder 1 PdntedRyped Nam@ SlgnaN Mongr Da Yeai t7d-'"'4 <br /> C Ir� <br /> z Transpgter2l'dnledfrypOd Name SMnaNre t <br /> MOnlh Day Year a � <br /> 1~ 1a PiscrePanq f1 <br /> LL <br /> r(W.Ois ;ncy Ind cadon Space <br /> ❑Quantity ❑Type ❑Xestdue ❑Portia!Releccon ❑FA ReVadian kms. t7c <br /> v c <br /> Mantled Refetel.Number: o1 <br /> W. Mlor <br /> ate Facility lw Generawr( U.S,EPAID Number ry <br /> o <br /> hone:ture o}Ntemale Fac1111y(or Genaralorl Monlh Day YeaeFs <br /> wous Waels Repoli Managemepl Method Codes fiecodes for hazeMods waste Vpatmanl.disposaland recydig syslams)3. 4.ied Facility Ormer prppeMlor CeAiflullon el receipt of hazardaas maladata oovened by the m2nilesl accept as wed In Item 1Baed Name Signature Month Day Year "�- <br /> 8¢OLC_O <br /> EPA Form 8700-22(lieu.t2-17)Previous editions are o6sulete, GENERATOR'S INITIAL COPY <br /> JASON GAITAN, EHS Page 2 of 8 <br />