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800 E. Pescadero Ave Record ID# PR0514340 <br /> 11/20/2020 Program: HW <br /> Photo 26: The following uniform hazardous waste manifest (006513769SKS) with no signed designated facility copy. <br /> .. SIC 6N1Pit 2Z'5091067 SKS <br /> Form Approead-CMB No-2050-0039 <br /> Please Pnnl or type.IForm destanI Ion use mr ante 12-pllMl hvaxrloerl Raspense Phone /.Mdntlert Tmclrlrrn Kama« <br /> GenemwlUNemde ZP� m a.Eme�e� d06513�69 SKS <br /> t1NIFGRM HpyARUCps CAL000139155 l l-i3d0-4.SL'.-1 yhN <br /> WASYE MANIFEST <br /> S.Ger+re da Nama rd a lkan Adarass Generemfa Site'di(I tlalerenitlmn metM1 Jaaamasl <br /> P'�n SHc^ Truck Leasing nTE10Ali':'SL <br /> :d10 ti PQ%radaro Avv CA9`.1304-979'- <br /> F ROGY n _ <br /> C.nemme.prw- - us.El Number <br /> a T.1-P-tar I cnmante Nem. T XR0 1du8.LO' <br /> SAFETY—KLEEN SYSTEMS INC <br /> r TmnVpdMP CampaaY ems <br /> U.S.EPN,O Number <br /> cL1RN HARBORS ENVIRONMENTAL SVC INC. Qtp�039322?»:r' <br /> 0.0eslgnabd Fddlln Nemaandaae Adam- CLERK HARBORB OF WILMINGTON LLC US LPA 10 N-Wr 00025197 <br /> 1737 EAST FNhII STREET wasee des <br /> Wrl-MINl9TON _A 90744 CF1T1Vd444298.'.'- <br /> 310-$35-9996 <br /> racltit's Phorre' <br /> 9e.115.DOT OeunP�hnduding Prrper Sluppdg Name.Hazsra pass,IB Number. 10.4onlatners <br /> NO r (loanhty Aljvel, 13.Walla Odea <br /> HM dna Packing Group lilanYl) �B <br /> o JON kCR(d HAzAROWS WASTE, SOLID <br /> 10IL FILTERSI <br /> w 2 <br /> w <br /> . c7 <br /> 3. <br /> 14,Special Handling lnsWcdons snot Atldilwnal lnfonna4on TSpcSJI 75406740 OFr <br /> ed,packagetl, <br /> Ne P—art, <br /> vCY #1-800-468-1760 inti r sx r TrII <br /> n r <br /> 15. GENERATOFUS10FFFRCN'S CE FICATI N:Ihereay deters Nat me contents laeonsignmenl are ya accuraleydesrn a-ve by die p'ope's[ppulgname,and are classified.packaged, pay Vear <br /> mail and lahelo6plaraide4 and ala in all'aspects in proper condition ror eanspod according to apPlirahle inlemadonal and national govemmenlei regulabona.it export shipment end 1 am to Pilin <br /> Expmler,I oerafy that thecontents of this censlgnmant Wei to the terms of the alldwd EPAAcknum gmentof tansent. <br /> I rEa t,that the waste minimization statement ide"1111 In lu CFR 2e2271e1lif I am alarge geanlitygenerawr)or @j lift am a small q'snAl generator}ie kue- <br /> GeneiasoiaYORemr's printedlTyped Name Signature Month pay_ Year <br /> F 15.Inlernadonal Shrpri ❑Import to a S. ❑Export frem U.S. Port of el nay Year <br /> T2nsporll signature ifw exports onlY}' Data leaving a 5.- i <br /> 17-TranspoderAtknuwledgmontMReoeiptol Malenais Oay Year <br /> ~TranepoHerl Prinledlryped,Narn� Signature Month Day_ Yea[ <br /> 0 <br /> or <br /> "' E'er <br /> Transporter 2 Pdriledflyped Name Signature mol Day Year <br /> d,Reiedlon <br /> a <br /> 16- <br /> discrepancy <br /> lea.Discrepancy Indlcaliu i Space ❑auandty LJ Type ❑Residua ❑Pal Rejection ❑Full Re}eclion <br /> Mal Relemnca Number: <br /> 166-Allamate Facility(or Generator) U.S.EPA ID Nul Day Year <br /> J <br /> U <br /> YQ.. facility's Phone: <br /> loc.Signature of Alternate Facllily(or Generator} Month Day Year <br /> a <br /> Z <br /> y19.Hazardous Waste Repod Management Mothod Codes il.e.,codes for hazardDuswaels traaemenl,disposal,and recycling systems) <br /> 0 1 2 d' ay Year <br /> 2a,Designated Fal Owner or Operator Cerbl1calion of receipt of hazardous metanals covered by the manifest except as noted in Ilam I Ba <br /> Pnnledfryped Name Signature Muni Day Year <br /> EPA Form 8700-22(Rev.3-05)Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> 3! 'hli_�147:sf1"rbi77 �y <br /> JASON GAITAN, REHS Page 26 of 34 <br />