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940 N. Central Ave. Record ID# PR0513647 <br /> 11/10/2020 Program: HW <br /> Photo 17: The following uniform hazardous waste manifest (0 1 8526864JJK) observed with found designated facility copy <br /> rForm proved.OMB Na.205&-0029 <br /> 11FF Please rine ar <br /> P type{Form designed far use on e111a{12-pitch)ypawrikar.) a.NmireatTnckhn7 Na.2050-0039 <br /> Phone /� _ `• <br /> z.PagelM 3.Emeyenq Response $sL'. JJK <br /> UNIFORM HAZARDOUS t.GerwnmrJU ^'l v JSK <br /> aAd:3 D u1�I vo <br /> WASTE MANIFEST CALOR 0 3 l O SY.B GanerelMa Sae AEaress l„d'sB1enl mae malting addreael <br /> G.Generalora Name and Mailing Atld— 3- <br /> FiRE9TOl0350e12 <br /> STI.CENTRALAVE 95376 s.-{ _ r1iT• <br /> GeaenWraphal 209 221-7164 'p. <br /> us.CADO 62770316 .Y:•i sy <br /> 6.ilansWi le Name •..JY— ' <br /> woRLD OIL E7JVlRONMFNTAL stIlmces ". <br /> U$.EPA 16 Number <br /> �.rrenapprmr2 company am. <br /> CAR000116422 <br /> WORLDWIDERECOVIllSYSMVIlNC, u5:i5PArUNa^itiat _ �. Kr <br /> e.owgnp�dgaa�: ene•$aeadarw�._,�_......_ � '•.y.y�a <br /> YM A17M;Ap MENT.INC. �. . <br /> 8 wusNIORIl 6 u 65365 AZRo006211A6 <br /> Foal- spheno' 911 R10.ContaWers 11.Tob1 12.Una ta Loden <br /> 1a.Wass' <br /> as. sb.u.$.DOT 0­6Wfingading Proper Shippai9 Nama,Huard Class.IG Number, NoType 4uanbN <br /> HM and Packingap lifenyll Gm =3 1's <br /> a •.� <br /> ?;ON-R1GRA LID AAZAD01/9 WAtyl SO (NOSNO I4-C0AF4DFMPILTEl .� P ' <br /> 2 _ �C CSC• � .:fr: 's <br /> 3. <br /> l 14.Speaal Fiantlling Instructions and Aetlitipnal lnfarmatron <br /> - .^>`",r,. .AP►FiOPRIRTE PEI f'R�OTECYIY� <br /> 1tl. GENEMTOR'S10FFEROR'S CERTFI[ATION:Thereby declare that V.contenla of lhis eonsignmenlare sully and accurately descrbaa above by rhe proper snipping name.arse era dIam the packaged. <br /> marked and R'SIOFFER rded,and are In all resp�ls In proper cnnotion for aanspon eccarding W applinahleimemadonel aM"monW govemmenlal Mgalaaons.lf eapurt shipment and 1 am the Primary raged. <br /> msOmt- <br /> Exporter,I oertrfy Ihal the.,toms of this consignmenr_to_W Ne terms of Iha attached EPAAd;nnwle�gome r o�II am a small q,-*ganaratorl Is bale. 1ary <br /> I cebly that Ne wawa minimize&on s>aremenl rdenaed in 40 CFR 262.27(a)[f I am a large gdarAly gen to)(i MWnN gay Year <br /> $gnaWra <br /> Gerrerahar'slORerofsPdName ntedRyped 1C" �y <br /> 1 year <br /> 16.himm.Wri Ilxnents Impmlt7 U.S. ❑Expoh fiom U.S. erNylex+e, <br /> 2Gale I'll U.S.: <br /> Tralapgder swalare(Wr evial only): yL_ <br /> W 17.TranspederAd,,Md dgnrantcf Recaiplof MatenaN Signal Month Day Yeas / <br /> �Transpan}r1 PdnfedlTVla�Nama / ear <br /> � <br /> O g a�f/ ~R 5i n 1JIe M._Ih Uay Year Year� l{'L � <br /> Transpodar2 PdntedYfyped Nama <br /> ear <br /> Space In <br /> K <br /> r , <br /> ta. <br /> Pa <br /> Grsueparrcy n <br /> 1 I]Reeldue partial Releudon ❑Full Relec:an <br /> iBa.tilsaepanctrolllien e LlGuanliry �Ty� <br /> Marl Ralaranrs Numhar: ectron <br /> US EPR ID Number <br /> 18d.MarlFaciliy loT Generatic) <br /> J <br /> �, veer <br /> ua. Faci!ilV's Phone: Manlh Aay Year <br /> w 16c.SignawreafWtemala I'll(or Gal,tea rl r y <br /> 4 leas } <br /> z <br /> 19-Hazale rdous Val Report Management Mel Codes(Le..modes for luzard0us waste Ireatmenl,disposal,and racydlnp ayslams) 4 <br /> w 1 2 3, <br /> 0 <br /> 2g.Uealgnaled F`anlily Owner or Opareloc Cedifica0on of recelpl of haxardoua matin lals revered by the ri l{est except as noted 1n Item 109 qi.a <br /> IpnaWre Month Day Year 'i_ <br /> 1 PrioledfTyped Nama <br /> rdar _RATO� <br /> EPA Farm B70-22IRay.3-05)Previous editions are obsolete, OESIGNATED FACILITY TO GENERATOR <br /> iATOR <br /> JASON GAITAN, REHS Page 17 of 19 <br />