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601 Darcy Pkwy. Record ID# PR0528650 <br /> 10/26/2020 Program: HW <br /> Photo 5: The following uniform hazardous waste manifest (013897393JJK) observed lacking designated facility copy. <br /> - -- tTM�MPs^�F 10alyy���wae <br /> Pbaaa nry t cum .PMe Ne.2V; s e. "tCv q.,^ ZTa90 <br /> far aae ,a°axn <br /> V^M,4L"WORWILFMSE ' �2 _ '" 'aw 9- 0 3897393 SSK <br /> - -°a'�ad'y arra ane C'4 L 0 0 0 4 2 4 e 1 7 � .ea.wpaa..n n.�m+•. w.a.,,� <br /> - a OLD DOMINION F'b q1t LgUREN AWN DOMINION D DOMINION FRE%GHT LINE INC- i�A,qZ <br /> 600 OLD DCO FLEET LINE INC- sol DARCY PARKWAY r 1-0lya 17TH g ET <br /> 'Mit",/yC 27� FATHROP CA 95330 CA apq}a <br /> e. u s.svAro s�o�roa ° <br /> Pa4rot �0 C A D 0 5 3 0 6 6 7 9 4 <br /> r,Tm�e ' mentalServices u.a,r=Pe lPNamn.r OF R°6n 6'suor-3 B <br /> e MEALCR <br /> TAah1N CIB11 <br /> s aakeabdF Us.EPA IP M�'ber a' � <br /> _vary Nana M SXa Mhtma <br /> 1m wESTEH6TD7REEf <br /> 1/J LONG BEACH CA"13 C A R D 7 8 4 0 9 0 1 9 .3. <br /> 1- <br /> �7 9a. A°.V,S.nOT 10.LmteXa�a 11.ToW 11.Lnu l3.WaeuC Esa <br /> HM ane Pxlwip a M1I NgPS'kPa9 Naw.MwMtHw.iP rnnrbar. Ouantlly Ntt.fJd. 4. <br /> -9 UN 1-7 00, POWILD Fle <br /> oc u rroNS S P �J°} �� o7s s ° a.aea <br /> U56 PROYBit YY8 <br /> CAbli 2, <br /> 2 NON RCV_A 1+A_ FzDOVS wA3W �2 DF p0 172 <br /> a. w�.V 1�1 CJS FU �� �„L /iLll Yr-4 JL1 �e i4. SGt.-,, R9� <br /> 1 S D U <br /> 14.5 ary ln°WtlloneaM,ltleel `lrarm.ma o1 xro T.Tr , <br /> USEM PIPER PPE JOB # 00-19-00 cr (PETROCH94 PO H 3SIWO-19, 1 t-' <br /> CAk C.�K 3�3 $ 3$7, <br /> 15. GENERATORI CERTIFICATION:Ih.0tya .mMtlreceMeMsMlMs carmgnrmMa:a nyy and ecuaa4sytl fart above by the proper s*V" W.Dkk "y <br /> m*0 aad lBbeledlraaC drM.and are In eN r Pecce 111 proper verde.for lnarg Wappl MB Inlama'dpnalaM nandtal gwwrnmer reWAW5o 0.4.A 9wenere and lam the P"-ery 1]a.P�epywY tr41®r <br /> EVorW I Wf*Na!the sanlence erfha C ipnmenl Cddwrrt m The terms of 1=11A AUmPM Wrdo1Cdlseor <br /> I oer5fy W th In 40 GFR 262.17(.)(KIamalarge q.rITy 8mwrmd)er(b)M I alp.erose puentlry penef Wto hue. <br /> wNOaerol do Maoeth �paa1y'a Yedr <br /> L� VL I 1'Ie-adHeWe FBoEY I: <br /> J tame ShpmenN 0hpnmu5. <br /> - Ell'- 5 Portefenhytedt <br /> TranvppRw agrraNrefra'emda oNy( natsleavhg u.5.. a FaauYs Pllale: <br /> 17 Tieup.WA*WaQr-I of Neoaipl of Melarlds °�° 1TG 3aJ1`alure d Ai <br /> Trarrspw4ar 1 Psindd/ryped Meme 8410- Alonrt Oa Yeas o <br /> J ` Q t <br /> 4 T naPorier2 PrinlodR Name NlgnaWra Idalsas nay Year <br /> 18.D—Unstea F. <br /> a t19.nlsaePanry P>h11BNTY9ad ylr <br /> 18a.D*Mrancy lneirahor Spare F�WanliN ❑Type ❑R.Wde ❑Penal Reit. Cl FA Relecyon <br /> Manifest Relerence Number. t�6LC-O g <br /> 19b.Abnrele Fack y(or Generelo U.S.EPA IO NrrmW <br /> U <br /> Faolit)'s Phone: <br /> r18c.Signature obMarnaw Facility{m Generator) hloi ih Oay Year -� <br /> d <br /> 19.Hararddls Waste Report Management WhodCod"(I a.codas for hal rdous waste Neatmenl.disposal,and recycling systema) <br /> O 1' 2 <br /> 20.0esignaled FaciI Omer or Operator.Cahi octan of 1`0 pt Of hasarrbua malaftals covered 4 the nlantleal except as noted In Itorn 18n <br /> Prinled/ryped Name nature Ih Day <br /> EPA Fom87O022{Rev.3-)5)Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> JASON GAITAN, EHS Page 5 of 8 <br />