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800 E. Pescadero Ave Record ID# PR0514340
<br /> 11/20/2020 Program: HW
<br /> Photo 21: The following uniform hazardous waste manifest (006285524SKS) with no signed designated facility copy.
<br /> ,;,,.e.s kr cad,+vessle and die eppepnale aeoreviahon fmm TatNe! t• .•yam I j
<br /> 1Ce Nmntaarxr-
<br /> TpN F r--TYPESOF CONFAPIERS I R
<br /> n may,papw.nr plastic Gags. OT=Dump uuck. 'ePoa. !.!'�'1n /,
<br /> MP 0-0
<br /> Form Appmvgtl OWN..
<br /> p plespc b.—prmns mases OW=Wooden dorms,caricas.keg,
<br /> I -ep3°, ... .-
<br /> bi cadans eases Irndadxrg NG=Hopper o,gondola yrs.
<br /> entear-scanms.mases TC Tank cors. ucksl. I Y�e•,�1•'.
<br /> TP=Podable leeks. I pill ryas Form Appreved.OMa No.2950-0039
<br /> Orllrris.ba""ke93 'i Ca 4eNlermX
<br /> and or[Iaean Nlanks hank WGY51 auelwrr p�.w �.rnnlbelTnchtn NemMr
<br /> ,^ gels'i nearest - � - — l 4 460 1750 {��'jL 5524 SKS
<br /> It...bi "a°r°r°Nene�"°rwlmp Add..
<br /> 'y tson 513—sire r""t" Le i cenemmrsslxnea,:,I�tarserenlranmwlry edd�xxl
<br /> i boieS,tM 1ptdl 9eanhly of wade.NeuM partial OWLS to lhB nearest F7279 E 1N escadera A,
<br /> �mtenlsrdeana's or Vacdona To ile eaeanrprap,cal,report puanahas sessmaMs, h 7RA y R
<br /> avis of that wdraamw you mrepon guanhder wM precision. .—rPhi— " --sera CA 3530k-9795
<br /> mead sbde4a be based on actual,measurements or reasmably aprurale mea I rlalae
<br /> Nie orad of r-`iF'E7Y-4{ us.EPA to mm�ber
<br /> pu3 be.Slipped-Conramer ppaoaes are Pot acceptable as estimates SYtj' IHC Tx i:'i<•_
<br /> via(lve9w6'Yoknne) r TrartSAoner7 Cnmryarry Name
<br /> I bvaas.ere 9pplO11nale abbmmatlon from Table II tbehow)fpr the unit of 11.5.EP0.10 Number
<br /> B.peaiAnaled Fxilliy Nang and 6i4a Mdress U.S.EPkID Number
<br /> TABLE I1.-UNlfS OF MEASURE
<br /> N=Qabicmet.. 12533 F11I19 !HC
<br /> aNy7 12533aoQRRhENTEF 31R aR a
<br /> P=Pounds CLPCKAMAS MA 97015-8_
<br /> �_e:
<br /> onM- T=Tons{2000 Founds) m Fra, Phone: 78A--0515 6R00000e"5197
<br /> IOOD klognisms) y-cub.Yards. f 9a. NO u S.DOT
<br /> HM end Patlat °'PXan fxhduding Pmpxr shipping Name.riazdrd CMss.n Numher, Ia.Cenuinem It.}mal l2-Un! 1a.Wasr9 Codes
<br /> i Cubic Meters.and Cudic Yards should Only be reported In s corp(if dnyil NO T'rW Wantily WIN.I.
<br /> V,bulk sjipnerlas such as rail rare,lank bucki orbarges kenh c 1. -
<br /> here,in p
<br /> althe. ti
<br /> rid sale waste miles In desrnde each waste stream derlafietl in Nem a - -
<br /> therate not redundant with federal trades must be enlaced here,in i 7
<br /> Sell,cedes which are most representative of fhe pnsperbes of Pre
<br /> Icessary for
<br /> zgruaazs and Addd�vca7lnfvrmadon Nher N
<br /> ,barmdes.
<br /> -arty spinal handiing a shipmenospecific Informatmn PiKess3ry for tonal 3 0
<br /> of or barlrrngof he materials,der the generators or ,consNWen[ Y
<br /> CDMs,such As waste prorate numbers,cunlamer codes,bar codes. units to
<br /> ers -`+
<br /> lb .Genent sisal may use this space w enter additonal 4 ^Us
<br /> '
<br /> about dram shipped matanals,such as chemical nacres,mnsNment n for which
<br /> cafe,a speafic gravity of wastes Wattled will,volume units In tory
<br /> wastes and
<br /> IW record hatted types Of federally required inrormadon for"On PCswaste 14.Spear Mi Inslmaaons and A011010 I*—i _
<br /> e p"ded on the mai lodUding any alternate facJiiy e-ollors. 7E6sT1'w 753911: - , ...-, , 'AS'•., }1N
<br /> sit tracking number of the oni incl mani16131 for related wastes and 3uralory to
<br /> W under secwld manifest;and Nie sale sfitabort of PCB waste ry, : �
<br /> iiri :::iw- #I--f50fb--468-1i&0 1541 / iF^T, �.
<br /> IoGserxce da[aS required under 40 CFR 7ff12o7.Generators, i RAT r• r_u r_�rvrrr ..
<br /> red to anter inforreadoo In Vi is Spam to meet stale regulatory alement.in l,5. GENERATCR'SlOFFEROR'S CERTIFICAnoN:Thereby declarethataha oxnlenls of thio consgnmenlare hilly and acture descdhed adwehy Na ptaper slopping n&ma,and are dassrtred.VarAa4�d•
<br /> marked and labefedlre—ded,and a,a in Bll fesp0[a8 in proper condil on for tranapod arrnrding In appi-bl.Intemat—iand naVonal go—ars,ul regoMdona-If export shipment and l am 1ne Primary
<br /> ave not Exporter,)«tri thatthe cements of ti consignment Mnlemlm do termso[meanedred EPAAWh ledgmem a[Consenl.
<br /> erdicaboos adore I certiy that the waste minlmiraeon slalement Identified In 40 CFR 26227(.)(,11 am a lalg.quantity generator)a Ib)Iq I am a smell quantity generator}s true.
<br /> sign.and dale the waste minimvation cam5oS inn Sralemerlt.In omplied Gomrsidesrpaeroes Pnntedrryped Nemo signature Monm Day Year
<br /> him cerlihration stasement(hose genersWrs who have not *mains the
<br /> x regulaaon from the duty to make a waste minimization per
<br /> Op2jdJ of RCRA are also certifying Ihat they haw complied ,per's r` 16.Imam Nonal Shreds ❑rmppd to U.S. ❑Expod from u.S. Pmldenbyiedl-_ —
<br /> ryol"Rements. The Generelof's Cariffirall also contains the ? Transporter signal—{for expodaonly} Dare Iasving U.S.,
<br /> shipment has been property prepared and n in proper lame,and 17.TransporWAc naMadgmemof Receiptel Maledals
<br /> the yappers Calltflrabonf.This coolant orlhe shippers s in proper ° w SigneNrB Month Day Ysar
<br /> )lows:'1 hereby dedirre that the COMPAis of this omental Transpomar I Fnntedrryped Name
<br /> wirstaly described above by the proper shipping name,and consents ofMonth Day
<br /> a Year
<br /> led and iabeledlpfararded,and are in all respects in propel If Consent"
<br /> .e Tfanspoder 2 FriHadfryped Nama Signature
<br /> ng to applicable Intematfonal and national governmental i,this party Ott
<br /> G
<br /> if andt I am the Pdmary Etlpoder,I codify that the contents of 7t. I-
<br /> e tarts of the attached EPA Acknowledgment of Consent." gnature to Discrepancy
<br /> inerator prepares Cha shipment for fransponation.This pang B T 1aa,Discrepancy indlradon Space ❑Ouani ❑Type ❑Residue ❑Partial Rejection ❑Foo Rejection
<br /> bkj Wl efafamenl as the offeror Of the Shipmentpee or agent
<br /> mayp epft lee lords, on behalf or fn the slgnalure Mamlem Reterance Number:
<br /> lemeal M me signature block prior to signing the ,m 15 may 1gb.Altemale Facility(or Generator) U,S EPAlU iNquil r
<br /> edicale that the individual Signs 85 the employee oragent
<br /> U
<br /> pxcepl the handwritten signature required in Item 15 may ua Facillrys phone:
<br /> w ',i'Slgnaluro ofAllemate Facility(ur Generator)LD NIom6 day Year
<br /> Q
<br /> 19.Hazardous wa510 Repot Management Method Codes{I,e.,codes Tor hazartlous wa81e Ireabnenl,dlsposet,end recycling systems} ,_ -
<br /> w
<br /> 10.Designated Facility Owner N Operalar.CeNfitation or receipt of hazardous materials hovered by the Inandsst aerept as noted In 11em 18a
<br /> 11 PrintelfRyped Name Signature nN bay Yea,
<br /> EPA Form 8700.22(Rev.3-05)Previuvs editions are obsclele GENERWOR'S INMAL i
<br /> JASON GAITAN, REHS Page 21 of 34
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