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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 8: The following uniform hazardous waste manifest (0 1 8526632JJK) observed lacking signed copy. <br /> Please print or typo.(Form designod for use an ellta p2-pitch} pewdtar. Farm Approved bMe No.2050-0099 <br /> UNIFORM HAZARDOUS s Gene" l9 Nunber 2 Peas 1 W 9.Emergenq Response Phme a.ManNay Rr dq Number s; <br /> PI©:rsn WASTE MANIFEST CALOOD31D471 1 7500r A"A4',M 018526fi32 SSK r, <br /> ll SGeneratoh(feme aM Mairwu�gAEdms f7gnerawfs Sae Fddresa ie o..k Nan meerg aedmasl <br /> p AND M.DBA 1 RACY CHFVROI.EET QANOOS '� �l � fir' <br /> s S40a AUTO PLAZA WAY <br /> iillei;r GA !db3D4 l <br /> t;�namNaePhpne 200 8564500 <br /> M!___Tran IComoany Neme U.S.EPA 10 Number 666 g� <br /> NVORI.D OIL ENVIFMONMENTAL SERVICES GADO 8277036 <br /> F Transputer 2 Gorrpn Name U.S.EPA Ie Namara, a <br /> WORLDWI RECOVERY SYSTEM INC LAR 0 0 0 1 7 5 4 2 2 <br /> 8.Oesaneed Fedlay Nemo and SIMAddieea U.S.FPAID Number <br /> rE9 MANAGEMENT,INC - <br /> 6300 US HIGHWAY 95 <br /> VLMA A% 135365 AZR000521146 <br /> FaOhtYs Phare: (928)344-9820 1 - - _ <br /> op 9a U.S.Dp7 Desmpmn(vdreang Proper Shipping Nama.HaTad Llass.ID Number, 19.tantainem N.Totek 12.Ung - -- <br /> 13.Wesla Codes <br /> HM antl Pedring GmbP(iFenyi} N^ T, 0—tity wuv i as NON-RCW IyA7AI7)­�U3 WASTE.SOLA](PAPER FILTERS) _52 J <br /> -- <br /> c7 <br /> SUyNPiWggyWATER <br /> WASTE <br /> IRTS/gRAKE <br /> sFOL VENT <br /> 4 - <br /> 19.Spedal Handling Insnams and AddiBonei Infatmadon .� <br /> EMERGENCY CONTACT CHEMTRIEC 1-SM424-9300 WOES TERMINAL L£RES CS `PROFILE M 981'182623NR3QAH04 I <br /> PAPER FILTERS' ^APPROPRIATE.PPE EQUIPMENT <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICARON:I harehydesi mal the canEenls afdas wnsignmentare fully and a a uratelysladambed am"by lhe"Dar shipping narrI ora dass�fied,pacMagea. <br /> marked and taeledlplaraided,and arsin all respeda in proper owerbon for Nanspon aomrding to applicable intema0onataM latienal govemmentel regutapons.If aapo'tshipmenl and I am the Primary <br /> Exporter,i cemfy that the consents of Ibis consignment mnlorm to the terms of the attache!EPAAcknowledgmenl of Consent, - <br /> i mnity malmewasre minimization statement idenfihetl In 48 CFR 2fi217(a)(if I am a targe quantity generator)or(b)9{I am a small quanaty gemator)is true. <br /> '�— <br /> �r GarerasorslOperoes PrintedFryped Name Slgnature Monro bay Year <br /> 7 1 <br /> + 16.ImemaLpnal Shipments Import to U.S. ❑F"Id Imre U.S. Pon of entyMirt <br /> r <br /> _ � iransponer agraiure[for expans onlyh Data iaawng U.S.: <br /> 17 Transpaner Aak< Wladgmenl of Recetpl ofMaterisle - <br /> OTransporter 1 Pnnte ayped Name Sgnalum M-th Day Year CONT C C/SIGNS <br /> 7 a <br /> 1 a Transporter 2 Prinlecyped Name SrUnaiura Monro Day Year <br /> 7 � <br /> r <br /> !I 18.Discrepancy <br /> I 1 Ba.Discrepancy Indication Space ❑Quantity ❑Type El[1 ❑Partial Releclwn ❑FNi Rejection <br /> +II Mani Reference Num4ey. <br /> 13b.Alternate Facility(ix Genofator} U.S EPA ID Number <br /> V <br /> LL FacrlrtYs Pi <br /> w 18c Signature or AReirnale Fadtity(or Genaralal Monro Day Year <br /> a <br /> z <br /> 19.Hazardous Waste ReW Mani Method Codes(ia,codes forhazardous waste treatment,disposal,and recycling systems) <br /> w 1 <br /> o 2_ 3.' 4 <br /> - <br /> E20.DeslgnaledfFaafill�yer or Operator Ccd+firationdl receipt of harardou4 rnaledal9 covered by Ne manilesl eacepl as paled+n Ilam lila <br /> ledlTypad SignatureMonth ay Year <br /> EPA Form 8700-22(Rev 3-05)Previous edit are ohsDlete. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 8 of 48 <br />