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601 Darcy Pkwy. Record ID# PR0528650 <br /> 10/26/2020 Program: HW <br /> Photo 6: The following uniform hazardous waste manifest (013897488JJK) observed lacking designated facility copy. <br /> MAI <br /> �n cA L o D o a s a B 1 T aoo czi-91a6 01-ARI .{JK _ <br /> -- - TMOMµA3V1D0M NRr,rELINE INC. Alt LAUREN OLD DOMINION FREIGHT LINE INCLLE _ <br /> apt L]ARGY pAfi6330 <br /> _ LATHROP CA 86330 _ <br /> A <br /> 8 7 9 4 <br /> a P'~M1 Nam a <br /> d�YOVERTONE ue. sa�r e <br /> WEST 1 �r,rex.mnr <br /> 1 cnoa.:R�CH CA 91 <br /> r�u. .amus norp.,e�r"dw.9 C A 0 O �°olNaaT° °BtatT <br /> °�v�an rs.are >��w,urr...a�acw.nw.,c., ,o.cafanns o�nun t fa.w.m.craw .rte eaD �!aau <br /> mTia <br /> 3 Npol WASTE F'larrvrlepb/9wtlo,n.o.s. 0001 551 Olt I <br /> fi Pr2 } WhS7D�SO[S = <br /> 'NON rzGrz.4 ,t ®01 DF 100 33l <br /> .sl�L-1 0 �D� t Z>�17DVS OO 1 <br /> x ss <br /> +F0LL�v�� IAJ>hS"F� .I31ssTf�P�1 � I5o � D <br /> wtTH rAct b, $ 11L 2ro D'F 20 Q � R cr.��^-&-I n 000E <br /> 19.USENargyM,q InEhudfine eel Atlaaa,el IaRGnneam , _ vR�Q [. <br /> USE PROPER PPE JOS $ 68-1B—ol ' ` l-L <br /> CA <br /> ! (PETROCHgq PO H35566-19) 1}1,p56083-Q ' arsgt � �b� <br /> pC 3-0 <br /> Gt 1css� YRt,r.,�, <br /> 10052-0tC *t.mwrsw.ti <br /> 15. GENFftATOR'8/pFpEROft' ERTIRppT10R:Inareby de[Ja,e tlal aD]nhnls of smltsignmaM ora hal an7 a ts, <br /> 'Pr and le6BII 05IIT.1l arB In en respaal9ln Y IKnsalsry Caaolbed alpyp Oy as P9Par slyppy>e tame aN Na clasaYliea,aaclagad, a � \ <br /> ller.loary/y oaf as Carrlenfa o1`019 rnn nmpar Cantla0tt far VeM1apoY arpeming}eappllwba hOmtatlonm aM 1161krta1 Rrnramman�}npaaaeng-Ir G14on F6VipnprAAMIBm a,s �ytgstbna_ <br /> I Newaalrha xasle minhnllatigl staltxr,anf gantlAetl la aeCFft 2szz7�s)IHei anima 6�EPnr+mrnor—tranroe Cgment Pshnery te.im, - <br /> fMsr Pnniedf Nama 9u Aeneateh m461(Irl ern aena6 quaaNy parer }1a We. T �f°"�ftriat yyy4 <br /> nay rear <br /> mremawna shpma a tom' ) <br /> bona ❑6rpNt+a U.e. <br /> Eq. from .s. <br /> Pwfot an <br /> Porfer agnalfuG 1hx aaPnr4 aMyJ l <br /> w 77.7rerreport�gdu�pN{aegmanfolRsreiptalMalenals ➢��"�US� �51apy"e`blwatre.,y� <br /> Trans I PdrPiDdrTyped Name ❑gytty <br /> Sgna a e <br /> z Transparfer2 PrinfedlTyped Name SlgnsWte �, <br /> FAonit< 0ey rear •wmt�. <br /> nt swa...a <br /> is.DlsnepancY � �+mmsv.taftya�r <br /> lea.1)[SMpancy tndhatwn Space El Quandry El Tl ❑ResldVecban Relatl�tl <br /> ❑Par6el Reie ❑Full <br /> Marl ReNranrs Number ILUayq,�y,�Uaytvpp� <br /> 19b,Manassas Fal(or Generator) ph, <br /> � U.S.EPA 10 Num4er �� <br /> v <br /> r+4. Facility's Phooa, <br /> S <br /> W 78c.Signature ofplfemale Faaliry{or Generator) <br /> "11% Day Year <br /> 19.Hazardous Waste Report Managalnent Method Codes(LI codes(Orharardaus waste trealrltent,disposal,and recycling syslarlal <br /> O 1. 2. 3- 4. <br /> 20,Desfgnaled Facility Owner or Operator.CerdOnation of receipt of hazardous matadals covered by the manResl exeepl as no*in ltem 16a <br /> Pfinf ypedName slgnalure Mel Day Yaar <br /> FPA form 8700.22(Rev.3-05)Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REOUVRF <br /> JASON GAITAN, EHS Page 6 of 8 <br />