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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 6: The following uniform hazardous waste manifest (018531260JJK) observed lacking signed copy. <br /> ir <br /> Tsaae/mrw rFwm ae use mefb la- kb rer 5Y k ! <br /> _ Fo,m roved oM8 No.203v-upao ff <br /> a�carrh.�x NnrRDOUS <br /> s <br /> WASTE/MX[FEBr � ) i l oswweralOpl A2F-D.�OD <br /> eye Neerralnen..xan arM19 rb..a7 ��� � �; <br /> �f �O <br /> ,Alae aee,n <br /> '77 <br /> live{ NMFNTAL 9ERVICFS u L n u n . 1 H �r fl ����L-P'r• d�' <br /> i rr�n:roves,a ear..uner Name u s.EPA Io rammer E ,��g��� a <br /> e aP.p�arad Pollee x,me,m sm+5a4raa, u s.FFnivNNrener i l l <br /> Ya M1NMcFMCNT.INC <br /> GS*65 HIGHWAY 05 <br /> '.'UMA GA a5365 <br /> Fadi Pama. I`�-A)3-04-gR28 f4 Z H U U U 5 2 y,1 4 li <br /> 4a ft S.DOT Desapbon tir Wlrra Proper 5l,p N Name,H-1 Cass,ID Numbv, 50.Ceraa,rers 11.Tota1 12-llNt <br /> MM ark PedwUGWVFanyl) Ne type ONarmy WWe[. 13.W»Sa Gotles <br /> 0 1NC"-RCRA HAZARDOUS WASTE.SOLID IOILY 50"D,PAPER FILTERR �13 M <br /> w <br /> 3 'NVASHWAT�R <br /> HASTE <br /> a <br /> 14.5pedal Rantlnng msauol—ACT <br /> Information _ y <br /> EMERGENCY CONT <br /> NT ACT C1fEW[TREC i 80d42493D0 WOES TERMINAL PROFILE M 9B1:OS PF CERES •WgTfEOHAL EPA <br /> 00M.981 NONE"APPROPRIATE PERSONAL PROTECTIVE EQi11PMf1lT <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICA'nON:I herebydedav that the c:*rts of this consignment era hilly and ac mWy desmbed above by the proper shlppmg name,and are Gashed,packaged, <br /> madted and laheledlplatarded,and are in all respects m pmpar wndUrr foruransport accordingto applicable intemasonaland nMonal g—mental regulations.if eapan shbrnenland 1 am the Pnmary .� <br /> Expader,i certify that <br /> Ne contents of Ihis wnsignmenl canlorm W fie terms or the attached EPAAcynoMedgmant of Con—L dee, <br /> 1 oerefy mal me waste mmimizabon statementidenafied in 40 CFR 282.27(a)Ig I am a large quanhty.ganerator)or D)ptl am a smahqu8any generator}is tme. <br /> GeneratorsrOReroesPrintad7yypdd Name /- SgnaNre - Month gay Year <br /> 16.Inlemabonalshrpmenls <br /> M Impod to U.S. Export hom U.S�I %Portaferuti ait: <br /> ear <br /> Transpoder signalure)for a Ports only): Dale leaving U.S.: <br /> or 77 TranspoulefACWraadedg+r[ern ar Reawpl of Materials <br /> Transpoaar I PmledlTyPed Name Signature Monti, gay Year <br /> 2 <br /> Transporter 2PdntedlfypedName Sigratura Month Day Yea[ G1V <br /> C <br /> r <br /> B.Discrepancy Year <br /> I 16a.Discrepancy Indication Spam ❑0uanbty ❑Type ❑Residue ❑Pallial Rejection ❑FA Re;eruon � <br /> I+I Manifest Reference Number <br /> 161b Alttsmale Fadelynar Ganerator) U S.EPA ID Number <br /> r <br /> U = <br /> LL Facililyes Phone: <br /> w 18c.Sgnalure of Alternate Faalily(or Generator) Month Day Year <br /> a <br /> z <br /> 14.Hazardous Waste Repon Management Method Codes(to.codes for hazardous waste treatment,disposal,and recolog systems) <br /> Ld I 2. <br /> 2a.Designated Facility Owner or Operator Cerafirabon of receipt of hazardous maledals covered try the manifest except as noled in Item 18a <br /> Pnnlad7ypeclName 3ignalure Manan Day Year <br /> EPA Form 9700-22(Rev.3-OS)Previous ediYonsare obsDlele. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 6 of 48 <br />