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800 E. Pescadero Ave Record ID# PR0514340 <br /> 11/20/2020 Program: HW <br /> Photo 27: The following uniform hazardous waste manifest (006513770SKS)with no signed designated facility copy. <br /> a, - a- ay _ ��ye• -------•••�aee[uamarem manm� 9�I a7R <br /> ��oz 1 Y .*ao aeddreeal <br /> desrPriedinraeeonellle(12.Wch)lypownlarl <br /> Falco Approvetl,OMB rao.71150.6039 vl-� <br /> emrlpNwiMr <br /> NA7KL <br /> r-i2Page lot 3Em4.Menlhel Treching NamWrWCRL0001.313I0651377wasrt Ma -i:00-h6[5-17+:0iWA aPanerxme So Add (d tld mftn mailingCLSafJP`ca9PremsU.S.EPA ID Nam00rTEN 8YSTENS INE: TXR08008t2Q+s <br /> ameU.5.EPA1D Number <br /> _gNRRS ENVIRONMENTFlL SVC INC. MAB2:73;-22F: <br /> s.OeSgipletlFaPkyNameaneSAeAd,1— THERM FLUIDS IMC U.SEPAIDN-er <br /> 12533 SE CFRPF_Ffr-r'11 PR <br /> 503-788-4516 CLACKAMA9 A OR 97015-89238 <br /> FaWI Phwre - - <br /> ea. 96.11.5,OOT OesuipUM(IPd"g Proper SNppN Name.Haasld faass,lb Number, 10.Ce,,a ers 11-Total 12 unn ta.wade Catlea <br /> HM and PaoWng C+euP{harry(} No. TY Q—Qy IM.fYd, <br /> 1. <br /> NDN--RCRR HWAIt6CdJ.S Wh's8TE So!,-jr, PHe- <br /> 1-1-0 011. FILTERS" <br /> z z. <br /> w <br /> u <br /> a <br /> a <br /> 15 spocsl NaMhng InsducM1ons and Add ,.I Ir trn do, <br /> TE'PuTPO 76406740 PEP3951 CE;Gb <br /> HR E'MF-ItGENCY 01-800-468^1760 (CM / SH / TVI) <br /> IS GENERA-ft 'wUCfA "' :Ihere d;h4 Na -e"wn wrisgnmen[a,e yandaaurak a5o�e EySFre pr6pe'-'Ippng name,and are i_,fd,packaged. <br /> marked aM IabeledrplamMed,and ae in all rmW,in proper dd k n Im Imnspwt according W appllmble inI—atimal no nabanal govemmenlal mgulab—d edpW shlpmenl and 1 am dre Pnmay <br /> bporh ImNFy yul IM1B[M19nq 01 Vi15 COnSignmEnt mnkrmb me lerm5 Mthe atlarh¢p EPA ApurpWlptlgm00l0i Consent. <br /> I cerlily Nal Ne wa51e mmlmizatldn stl[emenl ltlentifred ut W CFR 7521715}Sg I am a large paanliy genaralprl w(bi(rfl am a smart quanpyy generala,l is vue. <br /> CeneramrvDAemrs Pnnted,Typed Name SignaWre M.0 Day Year <br /> J 16.of—abaml SNp-,N <br /> f- ❑Impod to U.S- ❑Export hpm US. Pdll dlanuyrexd', <br /> Tfdn515daer 5tgnBluiB(for eapwtB pNy): Dale leaailrg U S� <br /> W 17.TrapSpdnBl A[kneATBdgmenl of Necaipt pl M"rlala <br /> bCTraospoder l Pn Il lyyed Name 5ignalwe Mmlh Oay Year <br /> N ( I <br /> Q 7ranspdrter 2 Prinledrtyped Name 5�gna[we Montn Day Yew <br /> K <br /> F <br /> Ie Discrepancy <br /> 15,0­parq lnerralion Space ❑0—cly [--]Type ❑Residua <br /> ❑Pallial Rejection ❑Fug Re,ealon <br /> 1196 Allernale Facility(or Generator) hlendesl Reierance Number. <br /> U.S.EPA IO Number <br /> U <br /> w FdGlfly'9 Phoae', <br /> IBc.SIgnawe ofAllarnele FAN11ylm Gweralbrf Month Day Yea, <br /> 2 <br /> 1g.Hazardous Wasie Repan Menagemenl Melhetl Cedds{i,e,mdos for nezartlous wasld ireatmenh tllsp0sal,antl recycling syslama) <br /> I <br /> I 26.11 s.gna[etl FaGlrty Ownerdr Operator CeNLwllon oi,ecelpl dl gaurtleus malenals covered by the manllesl ercepl as naetl In Ilam 185 <br /> PnntWyped Nam SrgnaWre Monlh Day Year <br /> a EPA Form 8105-22(Rev 3-05)Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 27 of 34 <br />