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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 3: The following uniform hazardous waste manifest (0 1 8530287JJK) observed lacking signed copy. <br /> _ Form red.OMB No 20564039 <br /> Please pnnl or type.(Form designed foruae on-rile 12 itdr)W ivv ter. 4.Man1MlTrectlng Nrueber <br /> UNIFORM HAZARDOUS 5.GeneraKK Iq Number 2 Page 10 3.EmngercYrYespOnse Phd+e E�]i1 •E JJ K <br /> WASTE MANIFEST A100030423 ICnrltl.^d -rel' ,JJI,J �a <br /> 5 GmreraloYa Nemo arrd 4aFmmppAddrMa Genenbrs Site Aodr9a+fir dTemnt then mexmg eddlea) <br /> Q AND M D6A TW1CY(;HEVROLET-Q!N00d <br /> 1 F�TO PLAZA WAY CA 95304 <br /> 209 836.4500 <br /> 6 7.n.olap,10 Us.EPAID Number <br /> s.rmnap a 1 yNemo CAD 02 R <br /> WORLD ENYIR()NMEN7AI SERVICES <br /> U.S.EMD Nambw <br /> -- - r.Tran�pwoe� om Name 2: <br /> UVORI1CDWPI�E RfCO1f£RY SYSTCM INt; CAR0001154 <br /> a.geelg�rafad FaC1Ky Neme eM 5ea Addnes U.S.EPAIO Numinr <br /> YEs rMNAGEMFM.INC <br /> 6500 U9 H11i 95 <br /> YUMA A2 95365 A Z R 0C 0 5 2 1 14(S <br /> Face SPhone: (92813449628 <br /> 9a 9b-US DDT DearVi iWcWgq pirri ShWg N—,Hazed Class.lDNrrber, 10.Conlamere 11.Tow 1g.Una 13.Ware Cedes <br /> HM and Pocking C—P(da7'11 No Type Duanaty <br /> Cad 1 NON-RCRA HAZARD6U'i WASTE..SOLID(PAPER EILTER6) <br /> i- <br /> ��tr� UNYV�E <br /> � i z <br /> � x <br /> 4 <br /> 14.Spetlal Hantlring lnstmdiona and Additional Infwmatldn <br /> EMEF40ENCY CONTACT:CNEMIrii 1-800424 9300 WOES TERMINAL.CFRE.S 17r,1LHG,v 961:171. M911 0 SBI -a <br /> 16_-6,3 TNR.^aQANO0'A PAPER FILTERS- *APPROPRIATE PPE EQUIPMENT <br /> _ <br /> 15 GENERATOR'S10FFEROR'SCERTIFICATION: hereby declare tat the coauanLs of this consignment are fully,and accurately described above by are proper 5hlppmg name,ardaredasIed,packtged, <br /> marked aid IaDeleWplararder and are in all respeds in per condition for transport according m applimble inMrnatianal and nero,ei gwemmenW repbli ll esporl sAlprranl and tam the Pnmary <br /> Exporter,Ilelhi Intl me contents o}thisconsignment cin 40 Gm Ne Jennaor I a a Eirg EPAAcynwdellgmento[CansenL <br /> I celtly Nel Ne waste minim�zauon statement identified in 49 CFR 26227[a}{d I em a large gaanuly generaloq or(L)[d V am a small gvaahry generator)is core. <br /> - - - _ Ge-1,1sl011erofs PnntedrTyped Name Signature ktoau+ clay Year <br /> 1 <br /> 16.lnlemational Shipments I--I., <br /> SAFEDATAF- ❑Import to U.S. -- "LI Export hi U.S� Pon of eneylerit <br /> Ty s ? TianspMerslgnakire(fore:pontsonly): tate lei U.S: <br /> 17.TmnspaterAdTmAadgmpl o(Receipl ar Materials <br /> Transporter t PdnWrryped Now ,t Sgnature Month Day YeaT -� <br /> 0 �. <br /> a <br /> _ •tie < Transporter 2 PtlntedRyped Name{ Signalwa Month Day Year <br /> Id.Discrepancy <br /> S-rAfRTUp I lea.Dfscrepanrylndlration Space ❑Onantlry ❑7vpe Residue ❑late ial Ra}actlan ❑wu Relectiotl <br /> - Ipl Manirest Relerenca Number. <br /> �+ iBb.All-male Facility lw Genarelor� U.S.EP0,10 Nuni <br /> L3 <br /> �.. <br /> - Fardllrys Phone: <br /> --. � 18a Signature afAllemele FaCiGry[Dr Generator} Monty Bay Year <br /> a <br /> 19.Hazardous Waste Report Management Meshed Codes(10.wiles For hazaMous waste Nealmenl,dlspasal,and recycling systems) <br /> r=1�l: rn 3 4 <br /> LU 1. 7. <br /> 20.Designated Facility Owneror Operator Learreation Df receipt of hazardous materials covered by the manifest except as nded In Ilem f9a <br /> f Prinled/Typed Name signature N4ond1bary Year <br /> EPA Form 8700-22(Rev.3-05)Previous editions are obsolete, GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 3 of 48 <br />