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601 Darcy Pkwy. Record ID# PR0528650 <br /> 10/26/2020 Program: HW <br /> Photo 4: The following uniform hazardous waste manifest (013897392_J_JK)_observed lacking designated facility copy. <br /> 1 rrwwmar. r�a, .pN6 rsa.zesaooss <br /> 013897392 ,WK <br /> 0 4 2 A 6 1 7 Boo 624-91133" <br /> Art LAUREN AKJ1`4Girrwn.ra Elr'T a�r.arl <br /> LfNE ING. OLD DOMrN101`l FREIe3HT uNE IHG- 1 1 <br /> Y 6tI1 pARCY QAfitCWP.Y <br /> 360 VaTHROP OA a533o <br /> V s rJMIa M�•�awr <br /> nmentailSarvC.s C A D O s 3 S $ 8 7 8 4 r <br /> u. stow w,.ro.r <br /> a.nw ena s,r.eme.. v.s.eFnrox�.mar <br /> 8 OVERTON I <br /> ST 17'TH STREET <br /> BEACH CA 90613 <br /> tr.Tort ta.ur <br /> AE u.S�Or rkavb�r+rM 1+AMrhuper SMPVbB Iinw.Ha��a Oau.lo 3N.mEa�, � �'af°T" a—y <br /> KN aartPaWnppauvfxn»J <br /> VIAJ19Ct3, wAV"U #{hwL �u'�S pal DF ISO �sl <br /> N,o:� <br /> ' Ut,1 3 4 b`t, ASTlM 1 N r, FiJ4M t — <br /> flOD <br /> CoR-I 1Vti 3 S1 Q�C� 0D1 DM 12S P 55 <br /> x a 4Jnti'7?9i 001 D tgo 5 <br /> L[QVIDS, N-0-S. $r} <br /> No 0 <br /> wa' OLID C e 1g ©01 D 500 <br /> rc.apedel antlenp laawaaan endA4d�bonel lnformathn ( Lp�lf <br /> USE PROPER PPE JOB # U8-19–oo1q (PETRO t38M PO H3Sq0 –191 2 r OSS ��3CiX� <br /> iiIQO -2-?, tri �� <br /> 4 S Gf+4 6L r` ?S CA � q aaaa.arra <br /> i5. GENERATOR' FERoft'S CERRFIGATI011:Ihereey tledare that the eonleals otdns Ga^siAnmaM are tauyeM atr+�ratelyd W"— exprnr sti*g and lent rfe P-1 <br /> merxetl eiltl la6erd+plaraNea,Brltl ere m all rasparJs in proper rpWitlon far Nanepad eccoftlin9 to�'�Inle'rieW"el and netloaal 9o�r�^ <br /> Fxponer,lwrety that the rdrlenr of tlH¢oonsapaaanl oonfaen rothe terms al me atlaewa FPA�A knawled9nw^r bert amas�na9 quantlty generatml�tnra, <br /> I,e"tl+ar tna waste m pim flan a+aremenl o oMflea In na CFR ze2.zTlal lkla"'a Vasa que M9a�+1o'I <br /> canerarur stats Pdnreerrypee Name SIG. <br /> �. <br /> t' <br /> 1x.Inlemaeonalenipmenr �Impodre U.e- ❑Expadeom US P lent, <br /> F 9 <br /> x T aponer signan+re Sfw ermarte are)`): <br /> JZ Tra+sparterAduaaAadgmanl or RaealPI M Metedab Month Day Year <br /> Transporter 1 Pdn Name Signature <br /> k aS rat( <br /> a 9lRneWm Mash Day Year <br /> 4 7ransporter2 Pdntedlfyped Name <br /> of <br /> r <br /> 1B.Discrepan y <br /> 1} 1 ❑Residua ❑Panel Releceon FA R.,--q. <br /> 19a.0isaepancy Irld1[a0un Space �Ouanlily ❑T1'Pa <br /> +II Writes-Reiarance Number <br /> U S.EPA ID RufrAar <br /> 186,Allsmato Facilily(or Generales) <br /> J <br /> U <br /> Facility's Phone' Month Uay Yaar <br /> W <br /> Lac.Signalure of AJtemale Facllily(of Generator) <br /> 4 <br /> Z <br /> N19 Hazardous Waste Repoli Management Method Cactus(I.e„Wdas for hazardous watts treatnlant,disposal,and teaydVrg 9y91ullu) <br /> LU t 2. �. 4. <br /> 0 <br /> 20,Designaled Facility Omer a Operator Cedir"aon of recelpt of hazardous materds coaeled by the menilaM except as nuked in Item 18a Mond Oey Year <br /> Pnated,7yped Name Slgnawre <br /> EPA Form 8700-22(Rev 3-05)previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE LIF FlEQUIREU) <br /> JASON GAITAN, EHS Page 4 of 8 <br />