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940 N. Central Ave. Record ID# PR0513647 <br /> 11/10/2020 Program: HW <br /> Photo 16: The following uniform hazardous waste manifest (0 1 8526863JJK) observed with found designated facility copy. <br /> ma.r .1JK <br /> " p�852686� -,� <br /> µi1161,1 2.Page 1 a 3 EmergeiwY Respan5e Phorw <br /> Please PH,m type.(Foran deslkned ror use on elks(52 Pit hl NP6 (�Gr-Il fs24910D .d,°' 4 - <br /> I G¢r.eraOor 1p Numbs* roman mailirq addresal ;' 4 <br /> UNIFORMHA7l R000s CALOOO., '.1' JI; carerawrs sae AaNew V ditlere ,mob, .' <br /> WASTE MANIFELST - � - <br /> 5�6rerzmrs Namn Mal_lag <br /> R]aof l <br /> .. - CA 95378Epp. <br /> iFiALy4'Cf NTIfsLL AYE u S. <br /> L 20,=VT104 p p p 2827'03U <br /> _ GBnerator0 PhMB'. - 9 <br /> 6.Trzrrtpaderl Canpa YName U.S.EYAIUI'ivmh°r y'.:._. <br /> yrpmaai Erm�I�HTAG sEmneEs c A a fs o o i 76 a z z �:�►.F�`};e. <br /> YTrenspv 2III "iCOWA'y SMEM INC. .EPAI umber ! <br /> noA7R <br /> d <br /> p00621146 <br /> A- <br /> �WEME}17.I"C- ' <br /> 630p IFS HIIGHWAV fB5 66385 <br /> PUMA 11, al 12.Unk 13.Weste Dad°e <br /> Ta <br /> 16.Conr�Ynars GuantiN Wl ' <br /> Fadlll s plena, N&na HazaN Pass,lO Number. Nn. Typo <br /> y, an us,DOT Ei atip,onldaamapavarshlp� "fie <br /> alydPacrangCoupSlfeny1) �gp}iBENS1 <br /> a <br /> 1'hf41�RCp1l FfA7AN90!!3 WIVB><£.9013D(OM AND <br /> O <br /> = 2 <br /> c� <br /> 7. <br /> 4, <br /> � <br /> littwEaw� * «r 9u.- <br /> 14.SP-011 Handling Inslruclions and Adr denal tnludinew <br /> £M£il0EMC1 Cp►fiACT:CH?IIAT, 4 /'y <br /> - - the PmP� PMn9 rad shipment andl am the Primary <br /> ro oandilion l0r lrarePortacemdi'g WappVicaMa inlsma"I and nalwnal govemrcenlal regNations_HarPo <br /> ' 15. GENFRA70R'SlOFFEROR'S CERiIPiCATiON:Ihemby tledare Nal ma coalenls olthis consignment araimlenln�C�mtelY ds�n�d ehO'e <br /> marked andlay dlh'larard and are in all respects In 4 PeT ams ekadletl EFAA xnrnwied9 N Alam asrnall quantity generator}is We. M y Year <br /> 7 Erpadar,lranily mar metantenl5 of lhls.rd 1d.mifed in 40 CFI dl6N� a l am a large quantity genararor}0'1)I <br /> ;eh wastaminimizadan statement idendfied M 40 GFR 262 27(.)C Signature I a S <br /> FGsnerad III sPnnteNfYpaO <br /> O Espart fiom V.S. <br /> POR at le trylerat <br /> rias � l tPrtrems ❑ImpOdm U.S- Oele leavingll5.: <br /> s <br /> � = Tmnspeder signelure(for espons oaYl� 1Mnm gay Year as <br /> ~ K 17.Transpod6rAWladetlgmemdRece%rl of Matedals Signature <br /> I �Tran 1 PdntedrtyPed Name - <br /> r^ [�Ilr� /,r]v( Monro Dm Yaal <br /> 1' 0 .,, �{, signature <br /> a <br /> 4 Transporter P Prinli dRPPed Name <br /> K i <br /> 1Et ~ — ❑full Rel�lion <br /> Rele <br /> 1B.nisueParKY r1 ❑Residue ❑PaNal cbnn <br /> Fac Oil <br /> ,Cy lndira0.pn Spats Ohl TYPa <br /> i i! <br /> ((l 16C.. Marillesl Reference Num9er: <br /> 115.EPAIQ Number <br /> Vaar <br /> F 18b.A6emale FaCIFlN(or Ganewll <br /> ay Year <br /> I(I v Facture Phone, <br /> car 0 1Sc.Signature ofNwinate F4614(of Generamrl <br /> C <br /> Z <br /> N 19, d Management Method Codes(Le.,cntles for hazardauxwaslo vealmenl,tllepoaal,end recycling systeme) <br /> Hazardous Waste Rapo4 <br /> 1 2 Y'cal <br /> o SLI rator: l <br /> EPI . acility 010!191 or OpeCerltgrakon of recelpl of h=rdoo materials mvered by III ma tem 9nalurxcapt as nuked m 1,60 Ml pay Year <br /> 29f9esignaled FRA,�Qft <br /> PdniWalked Name .4, <br /> �I <br /> EPA Fo m 8700 22(REv.3 755)Prevlous editions are obsolete. ' 1 DESIGNATED FACILITY l GEh1ERATOR <br /> JASON GAITAN, REHS Page 16 of 19 <br />