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800 E. Pescadero Ave Record ID# PR0514340
<br /> 11/20/2020 Program: HW
<br /> Photo 31: The following uniform hazardous waste manifest (006520703 SKS) with no signed designated facility copy.
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<br /> FomnA proved-CM13No.295n-0039
<br /> Ha.PPnsePMrw x.NanlhHZrukln6ar, ���
<br /> Please pool or t .tFarm d091 rad[..use as stile t12-Pitch 'en1 p.Pape 1 ef 3.Eme&a°1Y 41ifd'1 71,10 06506703
<br /> ., - _ UNIFnNM HA7ARb0U9
<br /> t.Gaimmlor m Numtai CRI_0N01.3131:i5 l i-g18H-
<br /> WAwmv MANIFEST Oanerewra Mypddra..Ia mrtamm men macre addmsa7
<br /> l 5 annraforr.Neter ant MetllnOreaa
<br /> Nation hum Tablet/ F Penske Truck Leets itlp
<br /> mbsrard 1be1 nets abam r1m F Pets cadera Ave E-R 9:304--97'39
<br /> he apPreP
<br /> Grp GMfarrtars llJ° miners for eadr'Masme std IIiAGY m uS.EPA IO Number
<br /> nterma numoar olcon Mer, e9nerelora Phone, f%f4000081�5
<br /> me kPa oI caret CONYAINEPa c.rrempodv r Y Nemo
<br /> wlowl for TABLE t-TYPESOF OT=Dump 1r11Ck' �RFEI'Y-HLEkN EYS'fGMS INC us-EPAIp Number
<br /> pW=Wooden drums.barrels,kegs.
<br /> BA i BahI ek th Papal.or pteado bags i Tr WPder 2G priny Nam.
<br /> r las k abuse,cartons,Asea. HO=Hopper or 90Mola tars.
<br /> eF=Fiber°p es.Paper aasea{inr3uding U 5.EPA 10 Number
<br /> CM=Metal baa TG=Tank sen, a oeag-ted Faeuuy Nam,and SkiAddres. 9RFETY-KI.EEN Sy9TF115r IfgC•
<br /> ropaRsl ,canna.cases. Tp.pon atanks. Eae* 88TH STREtZ
<br /> cw=wooden bo T_care°lei(tan I uaksl. CA X9.'.1) Cq 2NFi6h517
<br /> 4'SCRAMF'NTO
<br /> GY=cylinders- s,aarmIs,Nags S
<br /> OF=Fiberboard or pled,d.r n c,-3a6-4913
<br /> ON,-Metal dNms,barrels kegs- FecimyS Phena� In.eoniainers 11.total 12.Umt 13.waste codes
<br /> diel Mi15 M the ndarest 9a 9a u.5.d.T u.sutplion llnrLkitp Proper 5hpp,ia Na—HaII Coss.to Numbs+. No Type Qoan:itY Wt Nol,
<br /> yy TOM(pnenlay venbly of waste.Round partial
<br /> rep.,tit antil HM end Pading Grwpff snyll
<br /> tier.in dasgneled aoaes,inks talal q epasof`o To the Extentp rebl�. ()r R 1 3G
<br /> �reportquandllesw'g'p o 1' I'fi1N-RCRfl FfAZRR09U9 LIFYiTF_ f_IOU111
<br /> hula unit and do notenMr decimals t manta ureaseni WAYS"
<br /> ring aPpr°Pna t units of measure that Will allow ya' table as astrestes. (r[f2kfI PARTS WASHER EfO�UT ION 1
<br /> should he basedonacNal abil rent AOWP
<br /> 'este quartos:entered Gantainor CUP ?
<br /> ;4males of arlual quanates shiPP°d- for the emit of 2
<br /> f2.Umis of Measure(We igI, olume) 0
<br /> I in gin eted bcxes,the apprapdsm appmvabon from Tatle II @slow
<br /> ieasum. ABLE II-UNITS OF MEASURE
<br /> T _.
<br /> u4ic Meters.
<br /> G=Gatanstliquldsonlyl P'Pounds.
<br /> K=l(ilagrams, T or,(2080 pounds}
<br /> L-Lrtls(liquids only). Y=Gubla Yards. 4.
<br /> M ki
<br /> =Mabe.Tons(lira lograms}.
<br /> ant:Tons.Meme Tone,Gutty Melee, ,d and Cubic Yards stand only s,reported in
<br /> >nnection with very large bulk shipments.such 11 111 rrm.tank trucks,or aeries, ,a.special Handling Instructions and Additional Infarmation
<br /> eeadrrvastes4eamidentifiedintem Y5DtfiCfl 76987363 6tE2335i =B18�llJ CS6:E4
<br /> f3
<br /> Waste Godes I odes mull be entered here,in
<br /> bier up lo six federal and slate wash codas to dh federal
<br /> ernes of Sia
<br /> Presentative of ere PmP E14 HR EMERGENCY 1161-ftlb-468--176$ SCH / 5H /�FI} o
<br /> a.Slats waste codaslhatarenlredundantwi0rl era
<br /> b.state
<br /> M ms federal waste mdes which ere""I'm p Y a y hi rn name and ere Uassured,pacxaged.
<br /> alts 15- tTkGENERATOR'efOFFEROR'eueR[iFi ArioN: herebydederalhatm bene 5af>h'is rnnsignmenta be lntem�ad narantatl ratans govt ' tai raquVanors.if eupnrt shipment andlam the Primary
<br /> dal Handling prtsmrcUons and Add+lionaf fnformahogedfiC infbrma4on necessary for marked ant lalhr edlplac�Ned.and am in all respects in piepar condition for transport aemrding to aPPlira
<br /> 14.Spa t#al handling a shipmen4sp narel13horn necessary
<br /> Exporter l rertly that the writervs bf ma censignment mnf°im to me[arms of the nasi d EPAAarevnadgmenlof Conserv. ar VS We.
<br /> Generators may enter onyspe tame melanals under the 9a Irertilg I[iWI waste minlm'vatbn sta[emenl ldentifred in 40 CFR262 27(In F I Ore.large quantly mi,eratrn)or{4}(ill am a small quantity 9e^'wa 1
<br /> fiNnu.arthOgerrtainercades.barcodes. sgnaNm Monts Cav Year
<br /> gra propermanage rumsserdckin9 ace to enter addidanal Genemlursi0aemfs PdnledRyPBd Nama v,
<br /> handlers business pmrrsses,such d wash pro '
<br /> Generators also may use this sp ,
<br /> e,rssponsa guide numbers materials,such as chemical names.consatuenl
<br /> desr+iRo''s igfortnaaon about their shipped afwastes identified With volume units in r J 16.Inlemaponal Shipments ❑Import to U.S. ❑Esp°d room U.s. Port a1 snuyiexe - -
<br /> percenlages,Physical state,or spedbc gravity a
<br /> Tmnsp°rter signaNre(far airports°blYl: Gale leawng U.s
<br /> Item f2, Nmimed types Ol federally required rnformadon for which Old
<br /> IV 77 TmnaporterArknowledgmentat Rerslpt IN Materiels
<br /> may be used to record an alternate IarJfily 111 w
<br /> This space Y retarded wastes and 0 Transpwer l Printedrryped Name sVgneWre MonIN _ay ear
<br /> !Aare is no spec space Provided an the manifest.including y 4
<br /> a umber of Me Chip a-
<br /> and the SPecNraaon of PCB waste N a
<br /> feslgnadons;the manileseO ode a second manaes[�gal manifest for reye a Month Aay Year
<br /> e5idues that are re-sftipP ¢ Z Transporter 2 Pnnledrryped Name signaWre
<br /> bons and PCH ouNaf-service dames required under AP CFR meet
<br /> Generators, a
<br /> lescmp u. d to enter information in this space lo meetstate regulatory
<br /> nurever,cannot be reg ~
<br /> equirementa, } ♦ ,a.i)isaepancy
<br /> I.Generate�slOffem/5 Cedibcahors Ilfll I ISO.0ixrepi Indication space ❑Cueng{y ❑Residue ❑Parr l Rejection ❑FNl Rajec4on
<br /> generators
<br /> who have not ❑Type
<br /> he generator must read,sign and dare the waste minimization ceRificahan:farmer n
<br /> ulebod from the duty to mane a waste minimization Manitesl Rate.—Number
<br /> liege er waste minimization cer4fcebon statement,these g
<br /> sen exempted by:ramble or fag are also certifying that they have complied 1 U.S.EPAIO Number
<br /> 1ab.Altemale Facility{or Generate,}
<br /> opkahon under section 3002(b)pf RCRA J J
<br /> requirements The G6ng�m prepared ands In praper a ca
<br /> Rh the waste meimvafrpn req �
<br /> quilted atteslaapn that Ne shipment has b nl(eal Property The Content Of the shipper's I F; Facility:Phone
<br /> mditiad for bansportalion(Ike shipper's Ccin
<br /> proper shipping name,and 19 U.1
<br /> 78c.srgnalure bf Allarnate Fanldy lar Generator} Monet Day Year
<br /> obabon stalement S as fellows:"I hereby declare that the contents o is 4 r
<br /> nsignmenl are fully add accurately described above by the Potts in proper prof PP g z a
<br /> e dassi6ed,packaged,marked and lobeled nit mob,I andreagonal governmental
<br /> In all r"I z
<br /> 2drafding lo app t``a 19' 19.HaeOre..Waste Report Management Method Codes(I e.,codes for hep�Nous waste tmslmenl,disposal end recycling syslems)
<br /> ricil for tfanspOd 1 z, �, 1
<br /> ]ulaaons II expel shipment and I am the Primary Exporter.11"I that the contents o C3 f 114 1
<br /> s Consignmenlconform to the terms of the snacked EPA Acknox�edgmenl of Consort'
<br /> other than the generator Prepares the shipment for banselpmen. Gtl
<br /> this pally 20
<br /> hen a party 2d.Geslgnaled Facility Owner or Operator:Codification of receipt of hazardous materials covered by the manifest except as noted in Item 58a
<br /> sy also sign the shippers tar5ficatipn stalement as s'.oflerural Ne In the 5n print Pdeedlryped Name Signature Morin, Day Year
<br /> ng
<br /> Inere[vr or Manor perSp+tnel may prophet the wprds,'�c O'half of In the signature
<br /> adr or may hand wnla Nis Statement in the Nal thenad Iwdu,,,Signs asothe employee or agent EPA 8Gm
<br /> seralorlo4emrCartirmhon, EPA Form 8700.22(Rev.M5)Previous editions are obsolete, GENERAT06"I'S6P11T1ALCOPY
<br /> the named principal. uired In Item 15 may
<br /> All of the above information except the he
<br /> signature
<br /> I
<br /> --clod
<br /> JASON GAITAN, REHS Page 31 of 34
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