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601 Darcy Pkwy. Record ID# PR0528650 <br /> 10/26/2020 Program: HW <br /> Photo 3: The following uniform hazardous waste manifest (020351075JJK) observed lacking designated facility copy. <br /> Please print or type, <br /> UNIFORM HA7AR000S I.Genemlgd lO Hunter a:Pagel oy a_Em®ga yReepque Plana 4. Inst Tnepng Namgn.r�y C <br /> WASTEMANIFEST C A L 0 0 0 4 2 4 8 '1 7 1 tiWti,(4-L1'sd 020351075 JJK <br /> S,Geneplo(b plepM p7d,MaJlny(yd�gy _ av�ap��s�de�AQtl rid Se��u""n��mal'' addressY. <br /> � v wwru�tur.a sis:;{a; <br /> IT LINE INC. Ulf]DOs,allale�JF1�FKt.4aaee�I.1F�[1rdC. <br /> b00 4w DC1hS1111Ca1J'vYfi( 091 DARCY PAF RVI <br /> i3C 273GG C:.WZZ0 <br /> Generelor'a Phma } 3 In 8 2 2 6 'F 6 0 <br /> e,Transporter 1 Company Name 1+S.EPA IP Number r <br /> YdtPWll:;riVllWllil@n[�1 Z`ervICBB C:A U 0 b S 6 0 b 4! 4 <br /> _ 7.-Fmmapoder 2 Company Name U.S.EPA l0 Namber <br /> a�ad� spry 5rt¢pd U.5-EPAID Number <br /> -_ ad Gplgµa,279 �� I B,Oesi�d'cV.'xitlY C VV;A UN <br /> Funny K Iti4su WtS 4111 H S l ktti <br /> TmcW"aNuma' 3S I_V14(lbt-AUN c,AW131d C A D 0 2 6 4 0 9 0 1 9 <br /> a_Naa s' Facillry'aPhone-_ BW 827-6729 <br /> e*a" <br /> Ba 96.U.S,DDT I]asp ip3onlincludlrg Proper 5hipp^A Name.Hamrd(7asa.10 Nuriher. 19-Containers 11.Tatal 12-feat ta,y�ste Coaes <br /> HM and PacMing Group{il TM 0-a"rro[Y NN.Nanyll No. ad. � <br /> a7n y 1. <br /> pYU � 6386$T9 ; :r <br /> Mir w <br /> oS.FFA t7 <br /> 9.e Ep 1pt+um" . <br /> O 2 <br /> 8 4 9 0 1 9 3 <br /> GApaawa""c°°`af_5 <br /> au' .; <br /> 51 T-el tiM•v- <br /> Trv° Y <br /> ^.7I ��' J.'� �r}` t. 14.SpU:I:�nakYlkbuctionskYAtltlN�m`al�formation .. IYN;'1'NU�.HM.'M 1: N-341y"_y`� 1,�,[ 5C <br /> �. ,LAaI.:iJ�GA�{4Z� A�k4'431f � <br /> } 15 y 7 1 sh name,arra are dassffad,ParJraged. <br /> r t5. GENERATOR'SIOFFERORSCERTIFICA910N Therebydedaze metwe conler4a elthsmnslgnmp are lolly and acwreldY desnnbed ahora Ny�mep IGP xprnt ynpmentand lam>he Pmnary <br /> marFad and Ii rded,and one In all rcspem In gopm—I In Inanapahaxnrdmg b aPpFrabie Mamaeonaind national 4ov— Tegua <br /> Ea,ro.IcedllYme,thew laMs dthis.,,,fnm.i,j_mmmhe ter <br /> lmsofine ehated EPAPcknavneagmeM of Co nt <br /> Icerdfy thzi the waste 'rmzaUnstatement denied In 40 CFR 262 27{a)(if l am a large quanory ga9erawri er lNl(llama\email puanplb generawr)sfh�e,r <br /> 7 Name `u` l f <br /> J r Gerera fsi0flamrs Privq�YPad }}r !�/ Y . <br /> ICI — <br /> ��` �tyT«i J6—intemadonal Shipmenle �Im{raI NV.S- ❑ D <br /> Exparthrri- , aofenhylS <br /> 4 Galt U <br /> e laewmg 115.: <br /> P�4 }[36588"1" = Tnanspadersignawre liar exports ontyl' \ <br /> fisgOCF1 o' 17.Tmnspwter AdawwledgmentdReWtu MeuKiats .- r Mpµlh pa1 <br /> w <br /> ea PmraY 7mnaponer i PdntedlfYPed Name l Synaturep F^ _ {4' <br /> sNPP"�na^r �ylamO l.`�1,.}I5 11-1 ..SiYaYa.by wepma` I1e� a gnawle Monm Day <br /> aY410 re10a teat Tmns 2 PnnledryyPed Name - <br /> z f>od� <br /> M�atdY�o�A remmen� Oav q <br /> ye WUYa vans^3 aeae MadT I 1 I p: <br /> �aGT aaary to r <br /> m@Ildl o^'a"`�I� fie® 1B.Olssrepency <br /> 9�'"° � 5 d 1 Ba 0iscml>a�Y lndiagon Space ❑quantity ❑Type ❑Residue ❑PaNaV Rejacgpi ❑Pu4 Reiedion <br /> pmde^aYre Yaa' 1 Menden Reference Numbers <br /> "arra G S- ptor&r u.5.EPR 10 Ni <br /> mug (� 1 � 18b.NlemareFaodryforGeneratorY <br /> t4anei �y reu U <br /> 5gna! LL Fxilily9 Phme <br /> w IBc.Signature al Ahamate Facllliy for Ger,araWr) Mamh gay Year <br /> Signa:ur.. �FuANeV�°aa z <br /> �pyed RaR w 19.Hazardous Waste Repot Management Method Codes IIs.,miles for hazardous waste healmem,dlsp3sal,and regding syslenss) <br /> ❑R�Aa o <br /> � emaoa rbmb%r. u.S.EPRVO NvarAer 1 A N Operaor- <br /> lilt 20,0as�Hated Fanli Owner or I Cnrlifiwlion of reaeipl of haurdous matedala cmered by llle manliest eacspl a4 noted in Aem 18a <br /> Mw'h Day <br /> YW poMedRyped Name Signature Month Day Year <br /> EPA Form 8TOO-22(Rev,12-17)Previous editions are obsolete. GENERATOR'S INMAL COPY <br /> �d syyxms a - w'1-"6 7ff97'7(F?W 69) <br /> n.a r, Year 11ISIGNATFn Fn <br /> JASON GAITAN, EHS Page 3 of 8 <br />