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800 E. Pescadero Ave Record ID# PR0514340
<br /> 11/20/2020 Program: HW
<br /> Photo 30: The following uniform hazardous waste manifest (006520702SKS)with no signed designated facility copy.
<br /> i _4( $HED# 22549411,4 Farm Aprmved.OMBNa-20540.639
<br /> Please Phi or type_(Form designed ler use On elite 112 P1eml lyPa4rtdar.7 1N 3Emeipancy ResWmse Phone I.ManNeet Tnc tlNumbar ��w
<br /> 1.rnnram la Number 2.Pegs J
<br /> L - UNIFORM WARPOUH CAUbta0�38155 S I'tZlDid-4h&-17iatd
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<br /> WASTE MANIFEST Genemwls SAe Addrese til tld[ereM Nan mailing addrassl
<br /> Gemera4de Name eM Mallnq Address
<br /> aoryryg�^Tab„1el F Penske Truck Leasing
<br /> aapPpPnaleabbrene TAAC:Y Pescadero Ave CR 95304-9799
<br /> g and d� Ganaramra Riare. _ 11.s.ePAln Number
<br /> 6
<br /> .7wrip",1 company Name TKNOODO 1205
<br /> Es OPCoNT�T�pN''amgode dti dpa�R'I1P9�- SAFETY-KL'cEIY 8YE1-tFi9 INC us,EPAm Nemner
<br /> a5eage - HoP4ar irguir 7 Trerrsponu2Crmaa"rl— KAD03932i'2:�0
<br /> s G- 4 CLEAN HAR9ORS ENVIRONKNTRL SVC INC. u.s.erAloNrmr6er
<br /> �dudin4 TC=Ta a meaipmaNd Fadliy Name arrd slmAdd— CLEAN HARBORS SAN SC1SE
<br /> s TP°p0r�a�nksllankla 1 1@21 BERRYE59A ROAD CA 95133
<br /> n�Car9 SiN'1 JOSE ' C1�DrA59h9h310
<br /> lermis.le9s Faallry'aPh— A00-441-895?
<br /> �e M1ealaa{ IN Conlainars 11.Total 1211,11 17 yrvas.e Cctles
<br /> Nandry, s.Tm hex Do i ujile IS,,a 4u tnl ala aa. ab.u.S.DOT CeeainwnOndudlnB Pmper sluppirg Name,Hazard Gass,to rvvmber, Ne. Type rduamdtY wt L,
<br /> HM tine FecNmp Gmupfe am'11
<br /> plwas Ne loniTactca reF, V c7 223
<br /> or lraab°n di rreason;i atm o T NON RCRA HAZARMUS WASTE SOLIDS
<br /> a do-nl acdlal measuremeaRot aroaplyMe as aslim (DEBRIS, PE-ROtft)M HYDRMARHONS? '
<br /> 1 Container capad6es are WNl'ofma 2 2 sr+:_,.
<br /> mgp7
<br /> mfrom w ,y 8 � iif-F�'FTRIfEio^�an"^`aaL:�G1LFl
<br /> me} Table 11(00 cp
<br /> opnate ahhravi. 1!"
<br /> ll-t1NIY5 OF M—;-RE
<br /> -C1ole Melees, '.
<br /> P=Pouni Poundal
<br /> T_Tonsl
<br /> Y=Cubic Tarda.
<br /> hi 00Y be repodae n
<br /> Cubic Yard"unkliocks.ar b�N -
<br /> .lers.and ch as rail cels,
<br /> menta. n1'hred m nam la.Special HandlNg Imswsews and Atltlidonal Information
<br /> stream'de TSDtl6,I 76$27580 PE.2s953 L�' '
<br /> ba each waste retl here.in
<br /> Ste Codes to desdi as must be en tidies o1 the
<br /> redundant wish federal ova of the PmP
<br /> whictlare most rePresem i cN HR Ef RGEHCY N1=800-466-17fi0 (GH / 5K ! FFI1
<br /> scary for 1 1. G NE 'S 1 S C CA :I re Y dedare 1 a eco,tines a'T is rarsrgnmeM are y an aocu , rhed a a e Ami a i44in9 name,aid are dassirled,PacMagetl.
<br /> ddreonal rnrofmatron aljan nate Millenror aan50rl a¢aidin to appliWbk slemadanal and natural qu,emlantal agoaudns.llenpOdShrpmenlaMlldm Inti Primary
<br /> andp wilt info ter,er Other mporkearked andra that the ooldantlareS all g,merin proper co 0 9
<br /> pr 5hpment-sPNe genera FJyoner.I ceAify[bel the l'anlenls of thl5 LansignmeM rnMorcn to the kerns of the adachetl EPAArI<rwvdetlgmeN of Corlsant
<br /> unhand materials undo mlainercndes,baroodas, I IIsi Nal the waste minim¢ellan slaramenl Identified in 40 CFR 262271e11'd l am a large quantity gewreleryer(b)(d l am a small ouentlty ganemtmr}is we.
<br /> rohle nund.,,,o addi�nnsGNenl Signature Month Cay Maar
<br /> Waste p Nes space or enterGenerolmrarMmi s Pdntetlrtyped Name
<br /> uch as a use irsV mamas. v .
<br /> eneriii alsom Y all ya1 Units Vn
<br /> em
<br /> malanaisI 5u�jdenli5ed wilt
<br /> air shipped of wastes _ 76.In1emadmnal ahipmanls Import tout. ❑Eaporttmm US. Pate an"ileAL
<br /> �aGlic9ravitY nformaGmn fpv which = Cate leaving O.S:
<br /> federally required 1 Transporter signature(kr etpar+s onlyl'
<br /> es at led aliamale lauliry
<br /> led limited lY11indwill9any eded wasnas and w 17.TmnsporterA<knmaled9mrentd Re eiptMMaledals olh v ear
<br /> ted an the manifest anifas7 far,a n of PCB waste G Transporter 1 PrtnledRyped Name Signature hto Da Y
<br /> of the dri9inaV m calleat"' '' .i, v
<br /> ung nUrn second manifest:and40 C R 757.207.Gerlsralors, I. ( t
<br /> oder a Aired undo to meet slate regulalory R Transponer2 Pdntedrtyped Name - SignaWre Mnnlh Cay Yaar
<br /> dates req '
<br /> rvice in this space _
<br /> renter mformaadn
<br /> r
<br /> laiamenl.In 78.Discrepancy \
<br /> ;alidns minim;zirs cadtorsY�ihoM.haverton I t
<br /> waste 18a.Oiscfepanry Indiralion Space ❑Quantity ❑lyPa ❑Residue ❑Partai Rejectors ❑Put Rejection
<br /> and data the remennI tho enelaaeliDn
<br /> certiflra
<br /> bon ala a dory toy a 9 aas I ihei fheY have GompPed
<br /> ago Iron ra 0 also t fY cg F also aonlain5 b1e Mandasl Reference Number:
<br /> 2(b)of RIC aM1eralare GaArfi al 18h.wlemale Facility(or Generalbr) U.S.EPA 10 Numdar
<br /> In feMani The G prepared and is s prop
<br /> gemeat has been prepared
<br /> �ntenl of the shippers
<br /> difics the 6nnten s GI th9 ane,and IQi Facilitys Phone
<br /> e sh pPf herre. dedaro thata proper Shipp n in Pm
<br /> Per � 18c.Signa ore of Allemale priority(or Genera one ea
<br /> M h Oay Y r
<br /> flows: hurt agave by in all resPeds anlaI f-
<br /> x alely deet, rded,and are ovemm a
<br /> d and 1ebeledfp19 d pafional9 the contents df ,
<br /> inA aPPI'eabis intimation der 108011 inat CGnsent� � 19.Hazardous Wasle Report Management Method Codes(I e.,codes for hazardouewesle treatment,disposal,and lecyding systems)
<br /> ledgment GI in 3 d.
<br /> dre Primary Aaknow this party ' w 1 2,
<br /> nt and is a�chad EPA ottaten, r o
<br /> the toms of the a shipment fol fT 0 I mens.
<br /> generator prePales
<br /> the a offeror o{the stti Pe signawra
<br /> on etatemenl as th t7n behalf or In dT I 20.Designated Facility Owneror Operator.Certification of receipt of haZaedaus malenels covered by the manifest except as voted in Item lea
<br /> tertlfica4 ewdrtls, +fill Pnnledr7yped Name Signature n Carl Year
<br /> net may prePnn7 th nor tO he the Employee Gr aganl
<br /> s mauve Mock Pns as V B
<br /> stalemanUn the 9.
<br /> n,to 1ndlcaie tltal,he Individual sig 75 may EI
<br /> nature required to it EPA Form 13700-22(Rev.3-05)Previous editions are obsalele, - GENERATOR'S iNIT1AL.COPY
<br /> t the handwntten slg 1)7-176830/1189197 ?1
<br /> a71Gn wo "
<br /> JASON GAITAN, REHS Page 30 of 34
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