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800 E. Pescadero Ave Record ID# PR0514340
<br /> 11/20/2020 Program: HW
<br /> Photo 24: The following uniform hazardous waste manifest (006461712SKS)with no signed designated facility copy.
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<br /> En;ar ma:;;rnwa ----... ahtirerrsaon 4w+a Please pdnl�hpe�P'rm" - - •,"�•�+-em-ni_—�` .' J—u
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<br /> TABLE I-TYPES OF CONTAINERS UHIFDINA W
<br /> IIA-audap atom NK,Or pr-N,begs of=Dump no WASTE 1b ->`sl- amu({ Gl ZlEa 7drF`a
<br /> CF=Fiberur plaspu bodes nmns rasa- ➢W=wavo.mum+,barer-, Gme�elexsI Fmm Apptwad.Oboe No.2050-0039
<br /> Ch1=Metal boxes,rnA—.LaeeS pn Gruding Hr HP"or vorm le(amPertSkl PleaSa Print er e.{Form tle5lgnetl for 115 I on elite(72-pitch l wdler.) 4.Meril Tnxklna Number
<br /> rprbrs. BAB UNIFORM HAv.RDDUs 1.Genemin ID Number 2 Paget M 3.Ems�9 ry NMWase Phoria �v C
<br /> cw=Wooden boxes.©Bons,©-es. TC Tank cls. TRACY WASTE MANIFEST CHL00813B 15:J 1 1-e'�a-4EB-1760 nJ
<br /> CY=L'Am rs. TP=Portable ranks. GeereraWra Ph 5Genenmfs Name aid laaillrg Addmss Gane,eWfs Slb Redress{xtldlemnl Nlen mailing eatlm551
<br /> OF=Fiberboard mplask dams.barrels,kegs TT'Cargo tanks Mans allrs'csL sfranolwda; (eeneke Truck [.easing
<br /> DM=WW damn,barrels,Was SHHFEEE�T 300 E PeIll k-rD Hve
<br /> 'rem rr rota&Ovanmy r inn-porta'; TRAry CA '33'3414-9719
<br /> Ener,indesynaled DO—them[alqualMyofwubil fioundp-mai una,mine nesm3l Gramra Ptmne. 2@2--S.3QJ--5050I y-5.EPA to Number
<br /> wFil and do nOt.*,d--b m haLaona.To Me axEant pmdlcai,repen 4venbtiea Brss.TmrmpoNer l CO L9 Name T x 8000081205
<br /> —9aPPmPlateuniteofma—me last wlNarbwyou toreportgMaMJeeWith preclswn. aoesiynmedr S()F"CTV-HLEEN 6Y9TETg5 INC
<br /> Waste quantiles en Hrad should be based an dLtUBI madSWemanb arraa50nabN aIXem[e umber
<br /> r,T,enyptlar 2 Lompamy Neme 115,EPA IO N
<br /> esamaie-nf aLlual nuankres sNpped,Gmteirrer fePaclleS are not aP>epMlNa dB aahmdlBfi III
<br /> em 12.UIds of Measum(WelghYVU,—) Pea. Phone u.s.EPAID Numb&
<br /> Enter.mdesignated boxes.meappmprete ebbreWalM Nom TeEte Il{befo.')br Ne and of aCeslgnalea Fadury Name arra 511eaaNuaa THERMO FLUIDS INC
<br /> imainsuma 9a fl.0 125.33 SE CARPMER DR
<br /> TABLE IL-uNITS OF MEAS 0RE ""' CLAG4iAMiI13 , OR 97015-121998 DpNQg,6liSE'S19-1'
<br /> G=Genf—fill only). N=CubedMeIsm 'NOW 543--788-4616
<br /> A-rfkrg$'rri P=Pohl - Facail's PnanB'.
<br /> O L(,�1 10 ConUiners 5,.Tom1 12.UnA 13.Waste Lpdea
<br /> L=Liters tlOuklaenly). T=Tms(2000 Pound-). - sa. 9e uS.DGToasmplmn MSlutli�Pr per-Hipping Nama,Harerd Class.to number. No Tyaa Dmntily wlNol.
<br /> M=Msbrm Tore(lOgu kuogranal Y=CWic,yerda, Z p Hhl and PacNlly Grm+O Gr enV11
<br /> rte:Tons.McNc Tons.Cubic Meters.and CsNC Yards should oMy be reporWdln or I.r_dl:)N-R,CRA HAZARDOUS all SOLID Dill
<br /> meubon.0. ry large bulli shipm li Fal Saran care lank mrd:3,or all 0 (PRAINF_n/UN5Rn1l USED blI FILTERS)
<br /> snip to sx Wal and slate waste cades to climate each wade sheam identified fn Kern z z.
<br /> stale wastswdes ilial era not redlmdanl vdpl fede+al cedes must he enterer hare,In c�
<br /> Son b Lha fedesl waste modes wHitll ere moat repMaenrefive of the properties of Ne
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<br /> spe,ia2lJandring Mslnn7ions ardArydn'wnalfnlomle7arr '3.
<br /> nemtws may en�rany special handling a shipmenfspadfic inbrmapnn neces3ary for
<br /> pmpermartagemenfor VeeFingollhamaledafs underme generaroYs ororher r45p.ml Ham
<br /> }hers husme55 PmOdsaeS.SUCK as waste Pm64 numbel5,mnlainer Codes,ba..al
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<br /> Al guide numbers.Generefors also may use mrs spare to enreraddibonai
<br /> 'pave rnrun iabon about their shipped mallsuch as chemical names,conshhtent
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<br /> .,physical stale,or speciCrc gravity of wastes Idenb"fied wiN volume units in 24 HR E
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<br /> race may be used to)ill hmilad 06. GENERAT, 14 Special Handling InsWalions and Atla�IiOnal Infpmelinn
<br /> y typesorfederauyrequlretlmkmMlianfarwhirh TEiDtTPU 7600286Fi PE23951 20185 l
<br /> no specific space provided on the merited,including any arlemate fan[liry 'narked am
<br /> tions the ininfu sr nckin umber of the Exponar.l
<br /> gn ongiandthnt(esr(wial of
<br /> fPCslwaste loamtyma '2�4 HR EMERGENCY #1-Bbt7r-h6B-176iD (CH / SK / 7F1)
<br /> r Nal era reshipped under second manifest and the sperifirafion ofPCR wase
<br /> TO
<br /> ons and PC9 cutgfserl dates rsqulradunder40CFR7$1107 Generators, _ _and ar.clasail Pal
<br /> Lanrtpl ba 2gvired ha enter information In NlS spezlomeetstemregWatory > - 75. culled GENEend leheledfpacaOrded end aren all mspec�n proper wdirian For transport according le applla Me international andynatll l govemarl regula4mrs Ife�m"shroment and M Pmealy
<br /> nits. = 16.int malronal
<br /> Expoder,I aertiy)hat the contentscontentsof this mnsgnment—to.m to the taints orgre attached EPAAckrwNledgmenl of Consent
<br /> 'rorK✓Odernrs Cemkt;llons I c rpty that Mawasle mhim¢ationstatement Identified in 40CFR 262,27(a1(d I am a large quantitygenerator)orlb)till am a small rmni generator's hue. --
<br /> Trenepoder sign Month gay Year
<br /> i for most read,sign,and dale Na waste mionoFetlon ce,trhrzaop stalerneni In Careful sPMledrryped Name ---^bM _ 1
<br /> 77.TmnsporferA � ��
<br /> xaste minimlzaflon cer&Frcabon statemanC Kase generators who have not r Tr7 T.rarr 1 Prtr '�
<br /> )led by sialute or mpulaaon from the duty to make a waste mI,kr b,, � `�n
<br /> undersaction 3002b aIRCRA are also cor8 n Thal the have mm lied a J 16.Imemagona spinants ❑Export linin us. PonMen _
<br /> (} fl^9 y P AYE F ❑Impart to U.s. hyrexit:—
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<br /> Ieminimulationrequiremenls.The Generators Cemhcagon also conglns the 7ransporter7.y'I = Tmnsp wsignature(for exports only)'. Dale leaving us
<br /> station that the shipment has been properly prepared and is in proper C //J 17.TransporterAckrpwladgnairld ecelpl W Val
<br /> Yensponalion(Ihe shippers Car6firativnJ,T11e WFrlmf of the shippers ��T Transporter 1 Printed+iyped Name Signawre Mom Day Year
<br /> element is as follows:"I hereby declare that Ne omtanlsof this Is.Disrlepancy
<br /> Ire rullyand accutalely dsscnbed above by the proper shipping name,and a
<br /> mckaged,Marked and Iaboadf1phalanred,and are In all respects in proper 1az.Drsaapenu} z Tmnspaner2 PHnteMYPed Name Slgnamle Mol Oay veer
<br /> rel according 10 applicable international and national govemmenlal
<br /> �Al shlpal and I am the Primary Exporter,t ceNfy that the comer!-of ~
<br /> I conlolm 10 the tel of the attached EPA Acknowledgment of Censenl.° Ifih.Alf—I.Fa 18.Discrepancy
<br /> ler Than Ne generator prepares the shipment"'hansportalion,this perry Z; 1SO Discrepancy Indication Space [7Ouantily ❑Type ❑Rasltlue ❑Pal Rejection ❑Full ReVenioa
<br /> I shippers a0fi zdon statement as the offeror of the shipment
<br /> mrpersonnel may prel lNe words,-On behalf or in the signature LL Emily,Phone:
<br /> l write Nis Sfatamentin Ne agnalure block pnorfd 5ignirtg fie Idc.Signawre or Manifest Reference Numl'.
<br /> ell,to lndiCdle that the individual signs as The 01111i wgenl a = J
<br /> 1 Bb.AIlemale Faclliry for Genaralor) U.S.EPA ID Numhor
<br /> !fit N 19.Hazardous W L)
<br /> information except the hendwn8en signature required in Item 15 may o 1 u_ Farllll/s Phone:
<br /> I� Wo113c.51grtelure ofAltemata Fedlity(or Generalorl Momh 6:ar Year
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<br /> 20.Designated F _
<br /> Primedgyped Na 55 19,Hazardous Waste Report Managemenl Mill Codes(le-.codes kr hazardous waste Ire alment,disposal.and recydtng systems)
<br /> FPA Form 8700-22
<br /> 1 7 Iii Y c1�1$.?i 20.Designated Facility Oxneror Operator Cerdgralion of receipt of hazardous materials covered by Ns manllest except as noted in Item 15a
<br /> Printedlfyped Name Sil Month gay Year
<br /> EPA Form 87CO-22(Rov.3-05)Previous edilions are obsolete. GENERATOR'S INITIAL COPY
<br /> JASON GAITAN, REHS Page 24 of 34
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