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940 N. Central Ave. Record ID# PR0513647 <br /> 11/10/2020 Program: HW <br /> Photo 8: The following uniform hazardous waste manifest (0 1 8526863JJK) observed lacking designated facility copy. <br /> Farm .OMB NM 2050-Mg 1 1 <br /> _�S�f seOl PM type.(Fon^design1e.dcfao"rBUms1ee`on elle 112�iltlrl typeuNRlter} <br /> ZPdpLalel 3r ereaMaM <br /> IO Hm, 70 _ ^43TnCMna Numa•r8 <br /> 63 JJKPlePnnOrHARODus LA OOD- a5 `7(2Hry 4R018526 <br /> UIF �!} <br /> I rWAS7C MNAaNI,FEESSI gdd.0 Gennamla Slle Adtlreaa 4ldlAernnllhsn mel5ry aeelasa) _ <br /> s IIH'.ifTl[M�PF[il.'ss TIY f'S <br /> 1 ' gn0 N f.ENI RAr I'VE lay 9537E a _ <br /> ff71V%Y 2OFa:'=xr]On • <br /> Gerw�nMa%mn,, 11.5.EPA 19 N1)2 <br /> e.Tran 1 ny Name C A 1)0.8 2 7 7 0'16 <br /> - ' `p( ji E'HYIRONMFNTAC SERVICES , <br /> n�e� Gtr Us,EFA 10 Number <br /> T.� yyURLDYVI�E RECOVERY SYSTCM RVC CAR 0 0 0 1 7 5 4 2 2 • <br /> F_ _ namll.S.EPA1D Number _ <br /> IfCse <br /> '50US HIGHWAY 93 u Rh165 <br /> PUMA A'LR00052114614 � <br /> F3,10Pfunb. (928)344.982E 7 <br /> gp, .S.DOT D—iPW-duding Proper SNPphN Nam',Harard Cram.ID Number. te.ConlalnMa 11.101-1 12.UM1 <br /> U17,waM'Codes <br /> sa, andParkngGmupptanYYl No. T". Quarany wtml. INTI <br /> (T ; HM RDOLIS WA5lE;,laUi7IO1L ATJD A$;ORBEN7 1 1 <br /> - = t!!t]NRCRA HAZA 3b1 <br /> nM P Pl l }7 <br /> 4 <br /> 14.SPM ffGErrg Insw ON andAddl CHInPormasen 9 <br /> EMERGENCY CONTACT:CHEMiREC 1800-428-4}300 WOES FFRMINAE C4:Rf 5 c3 NyaCRGx 981 iTi'PROFILE R 9B5 <br /> 162623NRSFIR68901LAND ABSORBENT` 'APPROPRIATE PPE EgUIPMEPfT <br /> 15, GENERATOR"'OFFERDR'SCERTIFICATION:I hereby declare tnt the mnlentsof NiSw$'D meat are fully antl acaeratey desrnbe.ahytl proper ahippi%name.and `ssb ixe Packaged, 11 <br /> balked ane IabeleNp!ararded,antl are in all respects in proper mntlilion fd vanspmd svnmrr�ta-pplicable intemati^nal and natianaV mmeMat mguladons.lf expon sh'tpme <br /> Eapoder,cer01YInas lmicanteens seWconsignment ei,40 Gmthe termsof I. la <br /> EPAfItyge etulo hOd1 am asma14 a strue. <br /> IcerrAy.IKatlhe waste mNimiraaon statement tdengfiadin 40 CFR 282.271e1ldlamafal9e quanGly game 111 quem ly generaourll 1 <br /> _ Sign&bre Month Day Y I <br /> — GenemlarsfOlfe sFnmedrr�R�d -- r/ � ��� w <br /> 16 ln;mraeonaf5rnpments ❑Import to U.S. ❑Eapadfron U.S, Pod of emryiexih <br /> zDate teavimg U Sn <br /> Transporter signalure(Iar aapaRe only)': <br /> ¢ f7.T,a derAdmuw'IBd0e^f-f Ra-V Of Materials <br /> Signature Month Day Year <br /> WTransPonarl PdntediTypert Name <br /> O _ y l 1r/ r r lr-r <br /> 'DL. Mmnth Day Year j <br /> — i Signature <br /> Transponer 2 PnMaNTyped Name (( <br /> 19.Discreparay r 1 <br /> 1Be lndi.ton Space ❑Quantity 1-1 Tyre ❑Residue ❑Pasdal Rolachon ❑Fu4 Rejac7ion <br /> Marf4esl Reference NumtW: .,, ■ �� <br /> Y IBb.Allemala Faci6ly for GeneraWq U.S.EPA IO Numtet <br /> J <br /> U <br /> FaclNt�s Plgrre, Mo. Ce Year <br /> w 18c Signal-clWlamate Facility lar Generalaj o y <br /> 1 F r! <br /> = 1 <br /> } N 19 Ra-do.o Wasle Report Managamanl Melhod Codes(I e.codes lar haZanious waste eeatment.dlaposal,And(aeycling systems) <br /> ' W o 1 4. .A <br /> r a` tt <br /> I+ 20 Designated Facility Cifwv or Operator.C,111a11on of receipt of hazardous maledale envared by the manliest eitcepl a,need In Ilam 18a 1' <br /> I Signature Month Dey Year - <br /> d0.p�s {f PnnledRy➢ad Name 19 <br /> EPA Form 8700-22(Rev.3-05)Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> J <br /> print ndllrna <br /> JASON GAITAN, REHS Page 8 of 19 <br />