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800 E. Pescadero Ave Record ID# PR0514340
<br /> 11/20/2020 Program: HW
<br /> Photo 33: The following uniform hazardous waste manifest (007769568SKS) with signed designated facility copy.
<br /> .. br ea.h•.a.l�arta me ePP"'v.1 ,___ .'RIFI - b
<br /> �r�pnraari++sr Pleasepnntori s.Perm S
<br /> pY[gnre'ne' t_TYPES OF GONTAIFE Dump N,hags, A ( eetigned for ase on able t12.pp� T'y
<br /> T LP bags- owr_Weeden e� oha�m uNfF9RM I1 RDGNa 1 Ganar le Numn¢r 1IYPaWritell
<br /> WASTE MANIFEST
<br /> � mr ,c nuns:tl�s9 HG=NaPPa° a sce^s.emrs rveme a•a Mem„enmrasa CRL00013a 155 x_Paaelor a.Er ,^srnasm,:e Plea
<br /> sa,carwns,mases l"' ,5 II Aenske Truc Fr L Fo^"apyroved,OMEN.zaso-oos5
<br /> TG-Tank ra l 1"$SB-460-176Q 1.Man1l`.,.Cmrxl``9�Num a�
<br /> disteoll
<br /> wags,canons cases TP, he cargo mnh.+unk wchsL $00 E Aascatlero Ave9s�t°Amres,maaarear��,0065�La�p3 $KS
<br /> TRIP
<br /> trete,kegs. YT= Generalora Ph^rrv. 2 9- 95304-
<br /> f tesdc drums'be
<br /> e.TmnspuderfcomyanYNarne $30- 9799
<br /> ns,berlels.kegs. to the ne9�i SAFETY-f{LEEN SYSTEMS INC
<br /> ���Ins 1plak quanlily Ot Waste. tenlp2chcaiiePe W^Y Name U.S.EPAtp Numher
<br /> frscbons.Yn me�nquanunes with PreLl��rate �� _, TXR000061205
<br /> 'pl anaarda that will allow Y°u 1°rePO meats ar reasnnablya a.Des 1
<br /> labk,as estimates t05 P44h "A^clad Fedliry Name en0 Sig Addmga
<br /> 1'llg of meaaa don aLtual',,l l Bre net uS.EPA iD Nember
<br /> coredpuld be pass _
<br /> allanaae_'shWPed'Gerttairtef[+gP3Llit9a !Iha Anil Or u` ' I f✓t r 7',
<br /> ore fpregh'1Vornfnel sem
<br /> fable 11 tbeVnw!to 6 d N6 H� REE7 eia INC. p.S.EPAlO Number
<br /> Facile 'sPheng. 9I6-386-4953
<br /> �a6hravialinn CA 95$2$
<br /> he aPPbP"a MEASURE ga. 9h.u.a GDT It-rI lmn Ilnduaing Pmprr Slnppin Nemo,
<br /> TABLE I!.-t1NIT5 tlF M N=Cubic Meters. nlu and Ns N Group filanyll 9 Hazard pass,ID Numher. umoe0004517
<br /> lids only) P=p"Ir �a p,onr 1. Na11. r to cg^ue.gra11 TJ
<br /> uses NfI-RCRA HAZARDOUS N°. iYoa Du no a w° as wasrg cocas
<br /> T-Tons{ o WRBTE h we.rvm.
<br /> y.Cubic yards. A-29 (AQUEOUS PARTS WASHER SD UTION)D /
<br /> a{t01Da kElog'amsl. mpead in 6F �Q .
<br /> Yards should nal kbeor Gar9es_ w 2 G 134
<br /> Cubic Meters,and Cubk rs lank utln 'I
<br /> Tons. mems,such as roll ca 0 Item
<br /> f large bulk Ship its stream identified
<br /> des to d,,rl each Warts entered he, I n 7.
<br /> 21 and state waste�danl with
<br /> Iederal rade'must
<br /> of the
<br /> jes(hat are not rad most representative c
<br /> al waste codes which aB
<br /> nal inrorrrlation a(an necessary tm i
<br /> mg Inshudionsand Adddroorshipment-specific inrorm fent octet
<br /> rddng of ate materials under the genera er codes:bar cedes,
<br /> enter any'Pedal handling coni
<br /> gement or be waste profile numbers.aca W enter¢did"al 14.spacial Handling Innructions and Additional Iniognapon -
<br /> ,ocesses,such as V5e this sP constituent
<br /> s5 P Generators a so may emiCal names. 7SDE BCR
<br /> Ile numbers- ed msec ls,such anti with volume units In 769®7363 PE23951
<br /> 201
<br /> nationcaput theka IParev orwastes life rvJniCh - 24 HR ENERGENJ #I-800-•468-1760 ICH / 4
<br /> tS6.2
<br /> Ysicel slate,or sP aired infonrohon fo _ S1 11,1111
<br /> / TF I)
<br /> 5 ofledere11yreany araill to faalrty etas and 15, GeNERATDR'SIDPFEROR'S CERTIFiaATIDN:(herebytleda I Nal the eontenta ofthiseonsignmenl are lollyane aawatelytlesrntxd
<br /> �t
<br /> fd limited type B waste f- marked and iabeledrpiaLarded and are in all respects in proper oe^didon for hanspart aocvbin tot above the preps
<br /> f ,
<br /> ba used LO taco Ina maPl(es1 in pal"ItI L IOC f�e�fo oa PC 9 apPlicahle Inuemau°nal and rralior,al govem„>e 1Bl Cavo
<br /> ce providfld on Expwler,l caddy that the contents of he consignment cwrI"mme Tema;0 the adached EPAAcknowleZ"til of Consent, rsdrppingreme.and are tlassifiad.packaged
<br /> be spa number of the orkJ d the spedtti colors, I remAj mal Iha waste minimization andiemanl identified in 40 Cl25z.17Ia1 til l am a la a �0f15'a axpdt-Nim Bland I am YnePmriary
<br /> a mantfesl d order a second manifest; a jg1,2p t Gene r9 gaankty generatell w IN(A1 am¢'coca 7eanery
<br /> ed undo0 regulatory Gen�lorslr]derefs PdnledRypad llama
<br /> I PCsheep ser" es requiredOi ons spal 41 fR sig tuts eretml gN'a'
<br /> adpn in this space to m+aet sla w I l f,�,� ��f rryy
<br /> I PCB qut-0d niorm rv/ t,, L llwnm oar rear
<br /> t be required l0 a❑tar I 'I � 96,Intemauonal5hipmems ,` rro+�(t
<br /> statement.In ` _ ❑Import le[l S.
<br /> �twhohaveli TranspertersignatuB{to,eaPortsonlyl: � wn(m uS. Pon.1entrylerg',
<br /> 7fferots CerlrfcaEtons waste n minimization g n eramR be trate leeverg u.S,:
<br /> n and data the tgmeM,gloss San tpmimiza4en r7.iranspoderACNnowledpmenl of Receipt of Materials
<br /> noel read stg ' "Lon sta eke a waste mmPlled
<br /> Aon Garb m the duty 10 ming that ii have el 7ranspoder 3,PdnletlTyped Name
<br /> to mmimtr-e ulabon from ban also Centel the o - 5+//f.7N�" *�Z-G i/
<br /> by statute or rag of RCRA are also ceNlY Ilca Stgnatvn:
<br /> ler sectlon 3002(b)0 ,The Generators Certi end is in proper W Ire Montn CaY veer
<br /> roPedY Prep orad ski a 2 Pdntedfryped Name U-$� �,/ /
<br /> nen m B nt has ba fipalionS The Content Dt the pPgrs 8
<br /> ¢align gjr
<br /> �M��D� Si
<br /> uonthalrhashiI"i ee,cedi tensolthis�ma and Mnnm D� y
<br /> nsPora
<br /> radial ltheilil declare lhalhe PnOOner PDIn9 is.0lscmpill
<br /> 'I hereby b the P P acts in Proper
<br /> ement 15 as toll �y described above Y in all resp tae,Disc epancy lndi align Spaw
<br /> and arca lacerded,and are ovemmental ❑Quantity
<br /> e fully and label that[he contents°t ❑ripe
<br /> �adraged,marked aPPJCable inlemationodB dl certi�t g ❑Residua ❑Partal R"; JlLn ❑Fu11 Reiecbon
<br /> nspod ar,ce ding tam gra primary EkP knbvJ�edgmenl0 Consent.'
<br /> ,POrt shipment and ttacngd EPA Ae odatihn,this Achy u 18b.Allemate Fal{or Genaraeorl Manifest Rererenae Number
<br /> I conform to the terms Of the r meat for IransP , J
<br /> apes Me ship oryerOr of the shipment. S
<br /> Ih,plan the generetor Pref ell as the si nature us.EPA lD Namher
<br /> slatem !, � .
<br /> rte uppers cerl8cabon w,ords,'On"half or in the 1 r LL Facihly's Phone:
<br /> Ran lophnl Signature block p or W signing the
<br /> I
<br /> may P 5 a5 the amP10Yeg er agent w idc.Slgnafura ofNlemale Facility]or Generator]
<br /> flerorpa temenl In 01e sg r
<br /> I signs tdonlh pay Year
<br /> s s to indicate the'fie Individua 9 a
<br /> and turtle w 15 may Z
<br /> m}tem
<br /> or co (call yntl9n g required in LR30� R }g,Hazardous Waste Repel ManegemBnl Method Codes U 0.codas for hazardous waste Vasimenl,disposal,and recycling systems}
<br /> riniPa hand si nature req
<br /> n ekcapl lila w t
<br /> w n3 informal o H141
<br /> z. a. a.
<br /> I 20.Designated Fall Owner Cr Operator',Certification of receiptcl hazardous materiels Covered by the mantel except as noted in Ilem lea
<br /> rnPh18 a e _ �- gnat Mo in Day Year
<br /> EPA Form 8700-22{ll Previous editors drat OW1810 4L21ES&AKVDFACJTOGENERATOR
<br /> 1)14941/156023
<br /> JASON GAITAN, REHS Page 33 of 34
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