Laserfiche WebLink
940 N. Central Ave. Record ID# PR0513647 <br /> 11/10/2020 Program: HW <br /> Photo 7: The following uniform hazardous waste manifest(0 1 8526864JJK) observed lacking designated facility copy. <br /> �ao Di OFFICE <br /> ^ '- se an ogle 112�i1nh F.-Appravetl,OMB No.2050-0949 `` ,f 74 <br /> r 11 <br /> Iyp Ater. <br /> Please Prin[9r pe(Form de519nad�rxmla 10%ine— 2.Page 1 M a Emergency Resparree Phma 4.A ir°el Tmceln9 Number <br /> PIEi UNIFORM HAZARG.T L A L O o 0 i 7 0 3 9 6 1 (600)4:rL9,"00 018 2 6 8 - JJ K - <br /> WASTE MANIFEST caneretoro SitaAddross{a elnenntman mailirg>bI <br /> `. 5Generdm/s NafM and MaaingAtldrees <br /> 1- <br /> 940 IN EMRAL LAAVE' <br /> CA 95378 <br /> TRADY 209 2Z 7164 <br /> Ganeratoh Plarw' V.s.EPA I1111'2r <br /> S 4 Tre�sllaa°r1!,ampBny Name ENVIRONMENTAL SERVICES CRA 0'2 112 7 T 03' <br /> 1VORLD O1L <br /> °a <br /> CIS <br /> .EP0.10 Number <br /> t.rransnader 2 comPam N°n10 CAR 0 0 0 1 7 5 4 7 <br /> j W01;DWIDERECOVERY SYSTEM ING u.5.EPA IONumber <br /> 9.Oesipna09d FadF11'NemeaMaae Address 1 g I long Jl;tri <br /> Yes e1AnA6EMENr Inc � <br /> `e 8500119 HH3HWAY 95 A2 85385 A Z R 0 0 0 E 2 1 14 6 <br /> YU <br /> Fadi aphone. q2813,44-962R I <br /> Irdadi�proper Shipping Name,Hazard Glass.l0 Nianaer. 10.Containers 11.Total 12 Vnd 73,Waete idea I <br /> 9a. <br /> 90.j S c T OesaiMlonf Na Trye Ouaaty Wt.MM <br /> HM and Pacaing GrWpCd eRYIY <br /> 'NON.RCRA KAZACOM WASTE'SLID(NON-COPIFORMSNG FILTER`. "?3 - <br /> Y 0 <br /> ,,i l � qq,aqe aaap777+�+� <br /> a <br /> Y. <br /> 14.Special HoOling lnsWdlrans and Additional lnformalion `^ <br /> 3� EMERGENCY CONTACT-CiIiEMTREC 1 8064x48300 WOES FERk9NAL.CER£S C.9 iAf�PR9PRPROFlLE N�1631S3T1R5£4R5F.9 <br /> -1-� ErgUIPMENT`EMERGENCY CONTACT CHEMTR!68064249300* TRUCK - � -_ <br /> 15. GENERATOR'SIOFFEROR'S CERTIMATIOFI:I hereby declare that the wnoanls olthis wns;i are My and accurately described above by the proper shipying name,aid are dassifred,packaged, S l <br /> ` marketl aad IadeleNplarardad.antlare mall respects in proper oantlton for 1i acrprdirg m applicable intermational and national gave—%@m regulations_It eapart shipment and I am the Primary 1 a 0 1` <br /> a, Espoder,lcerif IMtthecon[enlsorlhiswnaignm .,e.m olthea3 shed EPAAsknowlagmentot CommnL / <br /> 1 c Miy[hal the waste mmimiaatron statementIden"dried in 40 GFR 262.27(a)lir I am a large quendty gersiri l0(N(I I am a small quantity generetal is we. Monty Day Year <br /> GenemmrsrOFemrs Ni,ledlTyped Name <br /> Signature <br /> j2 Ib.lnlamahonal Shipmen6 <br /> ❑lmpaft m U.S. ❑Exped rrem U.S.' �- Pon al entrylewl <br /> = Transporierslgnatwe ttur espons onlyj� Nate leafing V.S' _ 'y•.� <br /> W 17.7rznapoMr,4egnowPetlgmentmReceipt of Materials ' <br /> TransportBr 1 Priniedlryped New / Signature Manlh Day Year <br /> a h / <br /> T Z 7ransp i-er 2 Priniad+Typed Name SignaWre Month Pay Maar J <br /> 0: <br /> F <br /> } Ib.Dis—pancy <br /> 18a.-repancy IndicaWn Space ❑puppi 7ype ❑Residue ❑PalOal Ra]edlon ❑Full Rejection �� <br /> Manilesl Retemnca Number: <br /> 18b.A temala Faeiliiy(or Generator) u.5-EPA 0i <br /> J <br /> _ U <br /> w Faciliy's Phone: Monet gay Maar , <br /> l'-— 1dc.Signature olAllernale Faailiy{or Generator) <br /> 4 <br /> I Z <br /> N19.HazaMous Waste Report Management Method Codas ii e.codes for hazardous waste tlaetmenl,disposal,and recycling systems] 11 1 <br /> aw I 2 g 4. N <br /> 70.Designated Faniiy Owner air Operaloc CatllhCation of receipt of hazardous materials wverad by the manifest eacapl as hdetl in Item 1 Ba <br /> !fl Pnnletl["iJ Name Signatule �IA -1 <br /> EPA Furm 8700-22(Rey,3-D5)Previous editions are obsolete, GENERATOR'S INITIAL COPY , HY <br /> JASON GAITAN, REHS Page 7 of 19 <br />