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940 N. Central Ave. Record ID# PR0513647
<br /> 11/10/2020 Program: HW
<br /> Photo 12: The following uniform hazardous waste manifest (0 1 8529433JJK) observed lacking designated facility copy.
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<br /> for ea h Walla dntl the apPmPnAte ebbr ,,I III Tarty©k �'�T JI r. •:.; u„ _Air
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<br /> Fomr APPmved.OMB No.2050-0079
<br /> ILE 1- PES OF CONTAINERS cock I Ineasepdntortype.(Formdeagnedforuseenalifo{12-fatoh typewdfer.)
<br /> N Plasdle bags. DTDuM 2.Pa elol 3.Emargen Respc Fhone 4.Manrfesr Treckl n9 Nambar �s
<br /> ooden drums,barrels-kegs. ,I t.cgneMWr l0 Numbn g t 2 g 4 3 3 JJ K
<br /> cartons."as gw=W neola rare, UNIFORM NA2ANDOES m L n rl!l', U'1';r r; ,j s7 -
<br /> HG-Hopper or go WASTE MANIFEST
<br /> pse,linauding Generamrs srta nderass hr daterant than ma�Iirg addroeel
<br /> n 5.Ganammrs Namo and Ma�l>ng ptltlress `~
<br /> ms,rases. TIC=Took cars, ^ ��13&U
<br /> YP=Pdrtable looks. ■1 ,: a - -•1' ., '
<br /> hums,barrels,kegs. TT-cargo tanks{lash burksL 4 5,EPA 4U NuMPBI
<br /> kegs. Genarawry Phare t,-. -µ ay"•
<br /> I /Rr
<br /> -kdal qua nb[y el waste.Round parte]units to the nearest � � U.S.EPA I9 hlYlla`ar 1
<br /> rt amities 7.Tores ier2Cwapeny Name !.�_.9.. .• .
<br /> dmals or ha ,d To the emdent procural,repo qu - I -
<br /> illr6 that wi,allow you m rep-d Quarrames wllh precision. ( 115,EPAIONranber -�
<br /> d be based on actual measurements or reasonably atcdrate 8 �y PIMRW. resa
<br /> tipped.Container rapacmes are not accePreula asestimates, r,+ _ ZUUUN AIAMtDA S,I tiEEk
<br /> Nowme) cOMFRON CA iijiu r�
<br /> ,,,opriate abbreviation hon Table II"owl for the unit of fai e,Phone: {11015•'+r-1100 �
<br /> 9LE 11-UNfTS OF MEASURE aa- yh tl.S.OOT Oesrnprion(intlWingPmper9hippAgNama,H—rdclaea,IDNamix, 10,CentalMYs ii Tofat 12,Una 11Waste Codas .k
<br /> N=Cub]c Miters- 'I HM
<br /> and Packing Grrss, nyrl N. Type Duantity waNd.
<br /> P=Pounds. I t
<br /> r Tons[2MO Pounds}.
<br /> 0 R
<br /> 1
<br /> crams) duY=Ludic Yards. w
<br /> c Meters,and Cubic Yards should only be repoaad In 2 z
<br /> shipmert6.such as ne,cars,tank trucks.or barges
<br /> .walla codes b tlBSVrbe each waste sUaam a, hem, Item
<br /> dnot es w¢hI&are most
<br /> "It"encelaavr:Of the prop¢ she[area E
<br /> ions and AddRlonal rnrormaavn
<br /> penal handling or shipment-speaficintorma4un necessary to f .l
<br /> radung of the maf.majs ender Sae 9entarnermdes her codes
<br /> ss,such as waste pmgle numbers co
<br /> to spa IH nm'm91 wcv amaAndt al mr°mrauan
<br /> Genaratowilco]mailuse uc0 asithemocall tnameclficonsMWant -
<br /> 1 , r -t`r r r.(lltnl;l CHLMINk:G i•d0o-4a483410 WC3E:i rtNMl:lrtt •r,p�117k.fEFf7�YUil Pkk()I tLtSYt[l}4tIYMt frl
<br /> ittheirshiPp . r;HEM]REG 90"2493W-PORA110k:H.`Y10•A N37020" w
<br /> vrsPerrOc gravtlYef wastes rdnnuled with volnme dnilsin a
<br /> record limited 0,of lede[aily raqulred ini i int whirh I
<br /> is GENERATOR'SIOFFEROR'S CERTIFICATION.T hereby tletlere Thal[he contents ofNls wrwgnment me holy aM amretaty dasrnbad above Wthe proper stopping name,and are cWsslted,packaged,
<br /> pvided Gn the mamfe5r,melud'ine any
<br /> 5ifo alternate faatll�wY3 marked Arid labeledlpracardeq ane areIn all raepeGq inproper mndiaon forlranspMaccording toapptkaGe Inr—overal arid radon]govemmental rnguiebons.IIeapansnpmknlamdIamthe Pnmsry
<br /> and ha,,l re' that lite oonlenfsol Wa wn nmenl conform to the terms of the aaached EPAAdmwdetlgmeM of Consent.
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<br /> al m Elmo rHy rrs
<br /> 2ekirlg numbe Iwdity mat lYl9 waste minlmkalion srRlement idenkhetl In 40 CFR 2fi227{al(if ararya quantity generetoll or(b}(NlBmasmalk geanh{y genm-etoN la Vee,
<br /> I under a cond manrfesl.al Signature Manm gay Yaar
<br /> f-seMce dates requiredunua _ Tti ceremwrrJrm cors Pantadrtyped Name
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<br /> d la enter rnfonrt I in This s..
<br /> Fm8.ImemaaanaE Shiymenls
<br /> ❑Import a U.S. ❑Export Iran U.S. Pon of enaylexa.
<br /> tikafiunaaer one only]: Date l
<br /> rter sgnef°re pot eaning U.S
<br /> .:
<br /> gin..and 611'the waste miI1Vn172b eneraryOfe Iwhn ha�'B n nb In Tranepa
<br /> W 17.Trenspenw Adlrwwledgmem of Receipt of Malerrars
<br /> on certihCaflOFl SfalameFlh prose 9 t Pdr
<br /> K Transporlar id"typed Name SRualure
<br /> r regu3aden from has dutY10 maka.a waste hem a I Month Dar Y.
<br /> 10ZIbI of RC RA ate also cCr�Yy'rngthet-Aft
<br /> The Ganemi Carfilhut fon a160 C Trenspdner2 Pripted7 ad Nanx S nature
<br /> regerreriren[e. arad.arld�.fi m 9 Monm nay Yaar
<br /> sh¢finenl hes been pmp2dy Prez a.
<br /> 11 S Ppela wnificatwnl The rantenl of Ala ahi
<br /> I hereby declare Ihst the Cnntents nF Ihisname,'add' ]e.o�sr epanry
<br /> plows:- Iprepare 1 9 -'
<br /> narelely desut4ed above dy eco a P k tea.D�srui Indirsnan Space ❑Duanlay ❑T
<br /> ,pert and lebeledlpiacarded�and are in all resp - _ 1 ypa ❑Rasitlue ❑Penial Rejection ❑Full Ralectren 1
<br /> hi inapplicable inremaAPnal andrtaho^slgrn a int al
<br /> ml and I am the Pnmary Exporter,10061
<br /> mat the rnFltenkf
<br /> l
<br /> Manliest Reference Number
<br /> Are farms Of the aha0hed EPA AuknCA-10pmenl Of Censer 18b.Altnmare Family I.Generalorp US.EPA IDNumber
<br /> ares the shipment for lransppdalion,Ihrs Pa li
<br /> Foaraltrprep mepl ? 0
<br /> ,ed'Catoa slatamenl a6 Ane offerof ai Ate ship
<br /> -Or behalf or in the a]ghaWle ua. Fepoll>'s Phone:
<br /> Fray re nnf Me words, pair W"gnln9 Ote P lac.$ignawreolAllemale Fauh (or Generaror
<br /> tel map P A w 7 f Monet Day Year
<br /> a Is,e^InthethgnaWrebIoAp eeor q
<br /> Is,,rtdNa�Thal lyre individual signs as the employ Z
<br /> N19.Hazartlous Waste Report Management Method Codes(ie.,Ndee for hazardous waste Irealmenh mepesel.and recycling systems)
<br /> ni required In Ilam 15 h I o 2 7 -
<br /> an exCri the hefldwdden sig I f a,
<br /> ` r 20,Di signaled Facility Ower cr Oparelor CeNPwlh¢n of reeeilH al hazardous matelots covered by the manliest akcepl as nded In Item 16a
<br /> 11 PrintedlTyped Name Sign lure Mondm Day Year -
<br /> EPA Form OTOC-22(Rev.3.05)Previous edillOns are Obsolete
<br /> GENERATOR'S INITIAL COPY
<br /> JASON GAITAN, REHS Page 11 of 19
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