|
800 E. Pescadero Ave Record ID# PR0514340
<br /> 11/20/2020 Program: HW
<br /> Photo 29: The following uniform hazardous waste manifest (006520705SKS)with no signed designated facility copy.
<br /> m: f a 3 SK SHIP* 2_,a-5494T7e
<br /> m
<br /> (Fon,,,designetl for use on elite 12-@ch Form Approved.CMB No_2650-0039
<br /> E� '• ,SF. � ,I I P )
<br /> 3 m 5 �' 1 Genemin lO Nurndar
<br /> HP7J+R0005 )ryPewd�r prwne a.ManNeetTmcdlna Number
<br /> ,ra u 2 Peae 1 m 3.Emergencr Respnnae C ,, ,,,r C SKS ayasTEA1,ONIFEsr CAL00013E!15-, 06520 i J aiKa7
<br /> I I-6@10-4b6-t7Ee
<br /> e csnararora name era dlan�n9 Aaaresa
<br /> vyoodenm , P-100 Trtirk Least ng Geireralors sneandress la dincremmanma,lino addresal
<br /> or yyasdc 6N0 E Pescaci Rve
<br /> nders. dams•da
<br /> hairaa kegs a Round Pamal°�reP°rtq�rade, f RACY
<br /> cenaramra Phone, 409-B:d0-5050 CR 95304-9'79,
<br /> e.rmnaaonert company
<br /> 0 Vusalf was Iola)'Mandly°IwaaTO"e,"ad gPfad' w'u.ba iacn. .S.EPA In Number
<br /> aneet Ie SAFETY-'KLE' SYSTChIg INC 0
<br /> I nrortlors tnl lmdII"Y0110 repodguanorreaso..ar motes 1XRgFol10k1I22_-
<br /> L ddort^ malty tacaap 7.Tmnslaerer2Gompeny Neme
<br /> am ones of measure d aA actual measu eine no labia as esdma
<br /> Ca ERN HARBORS ENV! u.a.EPA 1G Nemder
<br /> Idbaodda"'Inercapacuias rtot RDlOp�NTRt. SVC fIIC. 1KRD03332 'S�
<br /> �usss entered show for rhea' a Uesigrlaled Faculty Name and SlkeAddress
<br /> alyuanu6a.ov'jo loheald6°"1 CLEAN HARBORS OF WILMINGTON LLC
<br /> 5qr edu nplfelVlnel strain US EPA 16 Number
<br /> of,efMeasure pare; epP'oprme 0690'a 17,47
<br /> 1737 EAST Ori 5T'Ir T
<br /> r devgnaledboaee. WIL141NOTDN a CA %744
<br /> VNITSCF ME 8VRCubid Mem' Facllr's Phone: 31q-i33g-9sg'3B CAID16444a29H3'j
<br /> a. TABLEII-
<br /> ukds Olo)L T ion Is�900 poVnds) 9a 9b.LL5.00T D"riplion(mcruding P,npar Steri Name,Haasd Glass,IB Namher. 10.ConLriners
<br /> ms. HM m Packing G—P Uranyl} ll.T 12,Unil 13.waste Lades
<br /> Kk9m ' T= No. Type Q.11ity WI.Nd
<br /> rams. Y 3 Cvhic Ye
<br /> Mab+opfHra{1000k�remsl' Yards sh°uId a14 be an o oo 1 I'ON-RCRA HAZARDOLIS WASTE, SOLID f7M C_c,. P 223
<br /> and ones da, (OII_ FILTERS)
<br /> dic Tons,Cultic Meters, N zars�lanX W
<br /> f°ns'Me largo bulk shlPmanks.suds as m ylream idenl2�0 Vn Rem w
<br /> tion wim ' ,,,be
<br /> each wade nt,rad hare.in w 2
<br /> /sole Godes codas W d Weral aadeserNstbe�pedm,of the cv
<br /> p a six federai and slate+ s�undantwilh Iadva ei me P
<br /> rte was codes tllalare not h dr are most rePre50"
<br /> t m the Iederal waste"des
<br /> w i wry far 3
<br /> meml-spedho"forma 5 0 races
<br /> pepia,Nend,lnsrruclions srd mill-9 or lnlurmek°n is or°Ne<
<br /> sire nandling or snip oder me ganewW es.
<br /> .carers may enter anyrUa�ng d bta malate fide numbers,Iprtlainer craddib e
<br /> ,,aper manageman o m enleraddi a.
<br /> sees,sure as waste R use this space W ns44uen1
<br /> iters busin9as Pte°rs.Generemrs d rwjtalenals.such as damlcal names,AVE r
<br /> u,de numbs tee rdentidad wim vdume
<br /> Isg�bmrapon about Ihe¢shipped
<br /> cavity of was 1a,Specht Handling Insrrucdons and Atlddional mfonnation
<br /> arta e' da smote.or spedfm 9 far which
<br /> :anlages.PhYM ,rely,me"d e"'i felon TSD:1J I '�-°'
<br /> 112. ,dllmileetyaeso-fred ItematelanilVry y60�lW94d NE�::9`�? CSG:
<br /> ndudin9 any aro,re]aded wastes am _
<br /> spare map be used to dad vn the manirest,'Inal manila¢mfication of PGB waste `t rt Fhi RGENGY 411-8urD•-4643-1760 L CH I SK l Tia is no specTl°space P n minder of fee ono andme sP ,;, ,r
<br /> FR 761.207 Generalvm. c cr--cc
<br /> ad undera oes manilesl oratory 13 GENeRATGR'S10FFEROR'S CERTIFICATION: hereby declare Ihar rhe ocrdema of ibis ansignmant are fully and aocuralely tlesrrbed alwve rhe
<br /> gnadens:the manges)tracki g dales required under 49 G by w°per shipping name,acid are classifies,packaged.
<br /> dues mal are re q'ut to meal stale reg ma>tied ane a==, am are"all respects In proper wndPoon for transport acwrding to applicable rraemational ane nalwnal
<br /> CB outaFsarvlce odor In this spa =r Erltener,Icedify mat the contenteaf this consignment oonlorm to the terms of the 5ltynhed EPAAcknowletlgment or Lo�senl. gO1'emmenlal regulalrons,If eapgn sdrpmentaMlam the Primary
<br /> ylpuons and P cored m enleriAd
<br /> cannot he req Z cerli(y that me waste mirvml 1.1 staremenridendhed in 40 CFR III Its)tin I am a taiga quantilygeneratorl or(b)fill am a smallquandtygenerator)istma.
<br /> ever,as lament In
<br /> tiramenls- lions tion cedifirabvn spa General.evW mr's Pdnrad/rypetl Neme
<br /> llerors Cedihca ma waste minimize who have not w �, Slgnawm
<br /> ;anerulo/sk0 n anIdate enema r;l ). 1 Mon" 'Cap Year
<br /> generalvr must read. g' difica. statement.mosa9 minimlzauon
<br /> m the duty to make a Waste have compiled a 18.Imemadonal Shipments
<br /> ling me waste mlmmiiakvn ce Ing mat IheY
<br /> AexempWdb,slabrlaer reguleao C9 ntalnsshe h = ❑Importlo V.S. p 1
<br /> ❑Ex ort from U.S. Pod of aniryfarib
<br /> of RCflA are oleo cadd7s GerdIffeanidi akw m z f Transporter signature(for exports only). Date leaving V.S.:
<br /> Dian 3Vt)quir the Generator 17,TmnsppderAclalvwledgmentof Recalptof Malariais
<br /> firadon underse uifements, ro edY Prepared and is in pmper's zr
<br /> e minimtiakon req The�ntani°{the shlpp }' Transposer 1 Phntedlfypad Name
<br /> me wau IP mast has been p P
<br /> aired atteslahvn maUo athiPPars sanibwtianl rE O r. J ti+l Signature
<br /> Ell for banspvda 'I hereby dZam that the-Rents of Inls name and a / m Year
<br /> lows= me proper 5hlpp g �
<br /> Mon Bay Y
<br /> rarely described a4ove dY cls in raper ra' ¢ Trartsporter2 pnnledfiyped Neme
<br /> mpbon slate mellnlan eau and are In all resile mmen*al
<br /> ygnmem era Y�madsed and la1 Die placarded, national9°va contents bf Signature Month
<br /> ardra9
<br /> 11 Die mtemalionel and thalma r Day Year
<br /> dassiflad.P rdin9 W apo EkPa r,l rANIY
<br /> diden for ImIn acro 1 am me Fir fulld9 all of Consent' I9b. 18 Blsrsapancy
<br /> SmPmenland of ma rt Chad EPA Acvdation,this Pert,
<br /> ulatior+s It etrpdA to gra leans menI for transp -+ tae.Bisndapancy IMlcadon Space
<br /> dansgrlmeni conform re are the ship shipment v ❑OuanidY Ll Type
<br /> oNer than me ge^amtor p p ml
<br /> es the 0 are,of the ship nature ti Residue ❑partlat Rejecdon
<br /> ❑Full Rejecdnn
<br /> rafiption stafem uetralt dr in me sig Facia)
<br /> Sp ago tea shPPefs rR words,"4n nin the u�i 1Aa.5
<br /> sre riot ince nor to sig 9 186.Alternate Facdily for GenamlaQ Manifest Reference Number.
<br /> ripe r5onnel maY P,p nature
<br /> block P in ee ar agent
<br /> peralvr ort7ffamis slatemeN In tris sig ns as the emP Y x
<br /> y;m may hand wale m indicate mal g1e indr�rtdual sig
<br /> U.S.EPA 10 Number
<br /> m 19 Naz cJ
<br /> lam"lot emr ci al, A. aired in 11em 15 maY ai Facillly's Phone:
<br /> deal. nature req D 7.
<br /> he named pmt t the bandwnnen 5+9 lac.Slgnalma vi Allemaro Facility dor Genemloq
<br /> nlormatldnexrzp ¢ Month gay Year
<br /> All o{ate above z
<br /> I-pnnlad. 20.I)saig
<br /> Prinledfij 13.Hazardous Waste Repan Management Memod Lotles{Le..cedes for hazardous wade IreaMenl disposal,and recycling systems}
<br /> 4.
<br /> EPA Farm 870
<br /> 20.Designated Fadlily Owner or Operator:C0111fi Von of receipt All us metedals covered by the manilesl except as Acted to Item IM
<br /> Pdnyed7Typed Name
<br /> Signatwe Month bay Year
<br /> EPA Farm 8700-22(Rev.3-0S)Previous ediyions are obsolete.
<br /> 11 7S t Xl X777 GENERATOR'S INITIAL COPY
<br /> JASON GAITAN, REHS Page 29 of 34
<br />
|