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800 E. Pescadero Ave Record ID# PR0514340 <br /> 11/20/2020 Program: HW <br /> Photo 28: The following uniform hazardous waste manifest (006100589SKS)with no signed designated facility copy. <br /> s+d TjPa1 .and Ma -- <br /> ror ^m;rrw sear was _ <br /> �" TA9LE 111'PES of CQNTA Og DT inrn all rts.bairels.ke94 J !ill SH i Feil <br /> or on <br /> Toa! <br /> deco Papei,ins mases. ��-WOpar or 90ndala Cars MFORM HA2ARnOUeranad renemlla In rJadmbm Ptd) r 3_FmergeaP7 ReaporHe Phxa 4.branlMar Trilna WNumhrroyad Che N0,295 39 79 <br /> Io �oM1s'ra5es lindJdH�9 TC'Taol ignks <br /> WASTE MANIFEST <br /> hIaii.n4Adtlrese _ 00 <br /> 7C; <br /> J SK <br /> maoxes.cad°"s'psas 1TT°Fort <br /> cerins Ranh wd'sl r r ems—i's siiv a—a in Qdlranl Nun memm eaeressl <br /> r t c r'r..uial <br /> sec aroma,be Is <br /> xega ::U .1✓� <br /> a0 or Pts a nearest Generaror'n Phone �'Q W"ga'` <br /> hNn1stiarrp s'kB9 tall units lot116 6.Trdnspenr I CemPany <br /> HAXName - s:3 O <br /> Cray )quantity of wade.RpNna pa l feppd quantihes E;f3iLTY- LN SY&TLVIS INCus,EPA IG Namhar <br /> fired belay <br /> .ala two bachons,YO the a'.tPre wah preusma 1%R000fl(31r.2� <br /> I mpodquantilies asonably artiumte 7.Tmneponer 2 <br /> Yo nPle,',tmdmatser mems or as eslimama. r Many Neme <br /> V,5-EP0.1b Nember <br /> g uml5 0l maaenl9lhalwll 8p B�meaSN are n ladle <br /> based On oia�ep <br /> enNrad shoaN be Cnnralner�egli eillas a.Geaignaled Facll€ly Name antl ails Address 11.5 EPAID Number <br /> rai quantities Intel. Ipw•)lor btevnil of T)icFtl4p FLU1D5 iNf.: <br /> aas0Iv"hwdamaf ation,,TableIl(ba 1?;a33 SE CRRWNTE-R DR <br /> sill abbreviation _ r 111-ACRIdMS f1R 97015-F�4$l !,flpFm+71N@c^�l>r <br /> nCd bpxas,the aPP1OP" Facilil)'s Phone `rQl.r_.111H-u W1G <br /> TABLE II.-UNITS Uf MEASURE:N-GSURE - <br /> JhIC MBIem- 9a at U.S.DOT Dexo Oon entlwinN Proper°Jit 1N.ConLiinMs 11.Tom4 12.11n1r <br /> tla only)- Pounds P pp'ng N®na,Naaam Gass.ID N�mbar, 13,'Nesla Codas <br /> [Siqui <br /> P ria 2000Pounds) HM and ParAmg Group lariyl) Na Type 4ienNN Valy,Cubk Yards, 4e I+atih--RCRA HAZARDOUS WASTE. SOLID ala 'O } <br /> Oona("od-I hdogrems)- be repon�In <br /> end Cubic Yards should only POled fftRAlNI�/UMLRFlINFPT] USED 111L FILTERS) <br /> strip Tons,Cubic Malars, cd as roll cam,rankwCfm•°" <br /> vertionge bufkshipmanls.su 1n Aem w 2. <br /> waste stream idenliaed 0 <br /> Ides des W describe each ust be entered <br /> federal and stale waste ca ledemi modes m ertlesol <br /> e codes Ilial ere not redundant with represeirl of the P'op 3 <br /> fell 1 s1e codes which am con <br /> eolso intolmadnn necessary Inr <br /> an�Rng fcss"fu s andAddilipnal Ielomra0on <br /> meyenrer any special handling or shipment-sp eneratorsor serer des <br /> f ma malenaI,under thee Ismer Bodes bar pe <br /> i rmlial enlor, ,h aswaalC P'fy u5 q Lh sprs ce°o onieraddlaonai went <br /> ansa Processes,nuc or use min space oe,o <br /> mtom also Y d with nam"anis in <br /> golds wmberst helreshipped materials. ,dr,ane atl with Nofu 14 special Handling mstrucaons am Addiliorrar Infama€ion <br /> dormaUonabau ��pmwty,ofwesiesi 'r5D1TPIJ Csfah <br /> •physics,shape,or spa infoorl for whlda <br /> limned types or federally mouired0rats fal OR rNrRCENCY 01-800-468-1750 (91S 1 TFIi <br /> ray be Used to record manifest,Induding any edea wastes and - n = a� <br /> spew pmvided on the final manliest forcem4on of pC0 waste 15 GENERA OR'•OFFEROR'a CERTIFICATION:I her des are dwtlhe coolants Nf Mia conslgrimemare yantl acouatety tlesrnbed above Dy Ne pmPersluPpirg name,aid are rlwo M_pachii <br /> the manifest Nackin9 number of anifest.end the SPec� Generalom. <br /> d undera sewnd ma 1.207- mashed and IabeleNplacarded and are in all reapeGs In proper contlitian for Nanspon accordVig in epplleabfe mternanonal and nagonal ga+ammanWt regtdaliona.It ext shipment and I am Ne Primary <br /> are .shipped aired-140 1761 state fegulatory Exporter, cartiry Mat Ilia wnfentsaflhis r"riaipnmrn conkrm W Ne terms M Ne adachetl EPAAcknaxledgmant of Conaenl <br /> and PCB out-01-servlce dates reQ I certify mat Nie waste minlmitil statement eenlifled In 40 Cl262.i:7[a1(If I am €arse inanely general ar @)lit I am a small quanmp ge"sratal is rTue. <br /> Irsel W required To enter Wemiahon In Nis space t0 SignaNra Mmlh Day YNdr <br /> G—mtofaloeemes Printedfpryed Name <br /> t <br /> SYp}laror's GerliSca <br /> and <br /> d <br /> n and data Ne waste rant ms 'mmers00 here 16.lntemauonal Shipmems <br /> a <br /> most road.990' <br /> ig' hcabon alalemenl,moss 9 = ❑Imponto U.5. ❑Exportfiom LLS. Pod of enlryrexn: , <br /> rile mrnimizalion certi to malu3 a waste m e"complied Transporter signature(for expons only). Dale leaving U.S. <br /> Mahon hom the duty That may have <br /> ad by statute or fag of RCRA ere also cem��"GenifJcadon aiso Contains Ilio w 17.TransponerAcknoa4adgmenl olReceiptof Materials <br /> ndersecaoP 3002() Transpaler 1 pknledRyped Name Signature Montn Day Year <br /> a minimization requirements.The Gamut and is ipropers - r ` <br /> I has been p P .fie cement of the shipP q .fir'"- <br /> aadpn fhaE thashipmen niryrallon) a <br /> nansportal[ilia shipper's ce ¢Transporter 2 PrrntedfTyped Name <br /> I hereby declare that the poniens o1 nisneme antl Signature Manlh Day Year <br /> I described above by the P'aPershlpp g rr <br /> atement is as fbPows:" ads in proper <br /> are fuey and acl1lrale y mental <br /> paged•marked and fabeledlplarztrded,and are in all fes nlenis of 19.Oisuepancy <br /> ranspdn appending to applicable IOlerry Eapel and Perri mage pe <br /> e Pdma7 Exporter,I cerNy I 1&a,11sol..IndireI Space 0 Ouarniry ❑Type <br /> l e.shliol ll and lamN I ❑Residua ❑Partial Relecpon ❑FuP Retactlon <br /> Ne shipment for Irenspol ion_this Party <br /> aril mnlDrm to Ne terms aF the agached EPA Acknowledgment of Oonsen4 <br /> other Nan Ne generator prepares P Mandeal Relarence Number <br /> antes the offeror of the shl man nature r <br /> els cel r,fion 010hr Wolds.0n behalf or In 019 stg C 186,Arternale Faculty(a GeneraWrf U.S.EPA ID Number <br /> the sropp re Idol Ne <br /> Olfe'llcm sonael may P P to s9gnmg the <br /> nature blopk P e amp or agent <br /> nano Will <br /> tris statement lin the t sl9 tai Fenrily'a Phone: <br /> Iror peri fiphon.t0 indka4e Nat the individual signs es Ili <br /> nature required in Item 15 may w lac.SignalDfAltomata Fecrhly(or Generator) Month Day Year <br /> pgmlpa1 t the handwntlen sig a <br /> above mformabon excep z <br /> 11,.11—daas Waste Rill Management 100sad Codes li e_codes Im hazardous wasle treatment,disposal,and recyding systems) <br /> 0 1 2 9. a. <br /> 20.Deal Fagllly Iyyneror Operator:CaNMalian of ra 1ptor hazardous matedata covered by the manliest aircepl as nried In Item tea <br /> Yllr PratedRyped Name Blgnalura Month Day Year <br /> EPA Form 8700-22(Rev.3-05)Previous editions we obsolete. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 28 of 34 <br />