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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 8170416JJK) observed lacking designated facility copy. <br /> Please Form Approved.OMB No-2050-0039 <br /> print.or type,(Feng designed cruse an elite 172-pitch)lypewdlect I of 3.Emergency Response Panne a Ma"hs Tr+�kh g tiumber, l <br /> UNIFORM HgZgR0005 1.esne2tor to Number 2.WASTE MANIFEST <br /> s.GeA EST U A E' Generatofs SiteAddresa f4dhierenl man mailing address} i <br /> er rots ted MOVAdlress <br /> W OII-EWIRONW-WAi.',firilry', �'•;, .; <br /> 1306 S.PANTAFroAVE <br /> C0MIRT Fpr 9ri4',2r l , <br /> Generators phone; 31A�.6$6.3gg4. U 5.EPAIC Number <br /> BTrena r;P,p ri ^T iO'1h <br /> wdertcnmpanrlvema � 4 r <br /> JIORL D Olt ENVIRONMENTAL SFM(,FS Us.EpA in Number TNSr7-OD3o ,r`: <br /> 7.Tmnapoder2Csmpeay Naarq CA('.r;'" - rK y,;r:.: <br /> WORI I)W I RECOVERY GY9TFM dNL us.EPAIG Number <br /> e.oavunaleu Fe;;ry endgiNMeraes Cly. " <br /> YF9 MANAG CMFNT fNC <br /> 6500 U^•TIIG, <br /> WAY 95 A!!7?rt.rt.rq l! I i <br /> YUMA <br /> Facin spoons: AZ <br /> 19'8044 4N?A 12.Unit ' <br /> I 1o.OSMamars 11.Thal 1a.waste coxes n'r <br /> ,{ HM and Pda rrg pq dM lintlutl"Prover ShilNtirg Name,tla=aM Class.ID Numb t. No TVPe au-try wt.Na �.i. •.• <br /> 1.r plrf anM}I l' 1,r <br /> 5 <br /> C -,'•r.'Cd Rt:RA rTA.2/VP.IWII'I WASTE.sal ID fr{ON C.ONfOh'MIMC;FII TERS) II <br /> .1 <br /> W <br /> w <br /> I �'S <br /> f <br /> 4. <br /> t� <br /> 'I 14.Spepal Handing Inanuclona and Additional lnluanadon _ - .. <br /> FMFROFN148131,424-9a40 WOES CDNTACT CNFMTRFr 148131,424-9aWOES TERMINAL 2n52f; APPRCi?I'tNlr.PF'R'(7TIAL PftnS ECTN _ t J <br /> r.rf /-'' PPOFII F sly^F;:'"1Tifi' i <br /> r n I'•.'r rr.�lli': -F"4i}iFA llrYr ri^d'—)'.]-TPO'X V r s _ <br /> sfied, cka9ed, <br /> 1 15. GENERATOR'VOFFEROR'S CFRT1FICAT1oN:I hereby dedara Nanta osntents of Iris wnsignmem era ruby and aaaLrelely described reguW ons lle:ryoR shipmen and am the Primary r i, <br /> marked add kakledlplararded,aM are on m perta m proper Wnddbon(or U—KdaccoNlllg A app ieadg ieniel e mmIL <br /> and nabenel gnnem <br /> Exporter,Ioem,trial the contents omnis canalgnmanr conform to the termsoftSa aaedled FPA tKy ce omt.11 or S fI am asmeu quanft gese�1er)1a moe <br /> I g that the waste,inimmUm statement jammed In 40 CFR 252,27Ea)IFI am alarge quantify genera Murch pay Year <br /> GenaratoryiNfemrs Prig"'Typed Name Signah+re a <br /> 16.En1emationa1 Shipments ❑Irnportm US_ ❑Export hnm U.S. pert of woy(exrt <br /> Z Gale Vea�mg UB.: <br /> rrenspenar signal.,.{for ezpons only}: <br /> ¢ 17 Transpod,rAckn(Wedgmeidof Receipt Gf Matadals Monro Day 'leaf <br /> WL Signature <br /> Transporter 1 PdnleMyp@d Name <br /> a <br /> es <br /> Signature Month pay Y <br /> S TranspMer 2 I'mil-dapped Name <br /> F- <br /> 4 <br /> a <br /> r <br /> J ♦ 18,Discrepancy <br /> ! I ❑Residue ❑Parllal Rejection ❑Full Refection <br /> laa.Olscrepancy lndlcauon Space �0uantlly �nPa <br /> Manilest Relene—Number <br /> U.S.EPA Ip Nvmtier <br /> I lab.Nlernals Focllrty(or Generator) <br /> V <br /> W FaC111W,Phone: Month pay )'ear <br /> . .rc, ;+ w tee Slgnalure ofAltemsts FedllRy(or Generalor) <br /> j llr z <br /> 59.Hazardous Waste Report Management Method Codes fls.,codes for hazardous waste"atment,dlaposal,end recydingsy5l0ms} <br /> 3. 4. <br /> - 20.0esignated Faallty owner or Operator COrtkallon of receipt of hazardous materials covered by the manitest except as Well In Viem 16a <br /> PdNodfryped Name Signature ManIN Day Year <br /> a ea <br /> EPA FOr n 6700.22(Rev.3.05)Previous odiGorrs are o4salete GENERATOR S INIT4AL C 'R <br /> AL COPY <br /> JASON GAITAN, REHS Page 12 of 19 <br />