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800 E. Pescadero Ave Record ID# PR0514340 <br /> 11/20/2020 Program: HW <br /> Photo 34: The following uniform hazardous waste manifest (006687604SKS)with no signed designated facility copy. <br /> gdl. UK SHIPM 228235677 <br /> prone, nlml e. Qorrereln lu++�r�oer zn.a1 e R FnimA wad OMB No.10560018 <br /> YNIPORM HAtaeoow r CRL000338I55 1 —$f .p of5 f1L�q 604 SKS <br /> ' WASTl MANIFC6T V B O <br /> aaalolp erne pMeilligA ra tell. reM l.aiaarenl man meAx�riealal <br /> erpeneke TrveN 1.eeelnp M1ePenelze TrurN L-asing <br /> RIFfaI1I PBox <br /> 7633 PR 19603-7635 880 E Peycndero Rve <br /> u.n.r.aar Pe.aa 809-830-5030 TRACY CA 95?A4-9799 _ <br /> e t5' 8VOTEMS INC u 6 FAI N1n°e' TXR000081205 x' <br /> I rCLEAN I1 R8URS ENVIRONMENTAL SVC INC, a E°Al6",rmn.r <br /> MAD03932YL;i8 <br /> nur�,Im�=leawear w^e nM spm nrulle.r CLEAN HARBORS SAN JOS <br /> Eue sFA16N�.ab.r <br /> 1OPI BERRYESSA ROAD r� <br /> SAN .105E I CA 98133 <br /> q08-441-8%2 CRD0:94943TIb 'a <br /> FAVIII I pheho <br /> ee pp Us 0tl16nolPamrlArlutlmO ProVar 5aWVlrp Neme.NpaIN G41.IO NmMIr, to Canlannrn Il'. 11.U"' "yy5N.rAa.1 <br /> NM a.a PerklnpGwo 4r MVH Nn TVP. Ouanlxy 00ry <br /> ' NON RCRA HAZARDOUS WASTE SOLIDS DM P 223 <br /> o (DEBRIS, PETROLEUM HYDROCARBON-0 `C <br /> m e NON-RCRR HAZARDOUS WASTE, SOLID DM r- 223 <br /> j5t0[l FILTERS} <br /> 1 <br /> I.spebalNandlininl�onsanaAddlaomllnbmaaon TSDaSJ 7966665/ PE23951 CSSI <br /> 24H EMERGENCY#881x-468-176$-CH/5K/TFI-Contract retained by genei ara y <br /> OI init'al ansnprter to addr <br /> IS GENERATOAVOFFEROR'5 CERTIFICATION:I herabY tlealam eral Ne contenb dthis consignmenlare lolly aM acuealely tlesrnbed.bore hY Ne proper shlpping narne,ab ale tlassiaed,parSagad, <br /> _*cd i,d bheledrplaram`ad,.,d are In all respects In propercandiUon Por tmnspoN aamrtlrng w appllrehle rnlemahmMartl nBaenal pee6mrrraMal mGulahms Il,.port shipment ab l am lna Pnmary <br /> Eappder.earl(,Ilial theo.ntenhd NIS cans:gnmenl contemn 1,14 lento Y the ate ad EPAAck1wgdGmentof Consent. <br /> I cedlry Nel Mawasle mint—a.s1a[emanl mananed ih 40 CFR 26227(.)(I(I am a brga qa dny gu�eralw)w(6}(ill wn,.mall Wanmy;e—a")Is hue <br /> Gene Tygemrs Pnn[e06Typed Name srenargre r.- I,1anA Cay vaal <br /> 16.lnremaboneshipmem ❑Impact to U.S. ❑Faporlhom Y.s. P6AiAwlryleub� <br /> = lmnspettar algnaNre(eon exNda only}: Date leeaing U.S'. <br /> X 17 Tmnspudss knnotxdgma of Re ipl of MRIenals <br /> T;am r I PPnwe Typed Name Sgnawm ` _ MOMh Day Maar <br /> q man Pdn Mamh pay Year <br /> K <br /> j1R Disuepal y <br /> ace Oisuepanry lrrdiwlan Spare 0—fty ❑Type ❑RaS&e ❑P.dui RejacWa ❑FuaP pcllon <br /> Manifest Wow.Number. <br /> IHb.Allamale Facilely lel Ganennwl U.S.EPAID Numbw <br /> V <br /> Facllify's Phnne. <br /> w 18c Slgnatufa dAflernale Facifty(ar Ganemdcr( Month Day Year <br /> x <br /> w19.NaTaldous wasfs Repod Managamenl Method Codes{I.e..code,for hazardous waste trealneent,dapmal.and—ydmg systems) <br /> aw 1 2. 0 4 <br /> 2R.Cesignated FniPiry Ownof or On,ratO Cedilchoon of mvelpl of hazardous matpiwl emmd by the manbm except as nated in Item 18a <br /> PnnIeVygqped Nanne ��77II PP l Slgnatme Month Day Yea, <br /> Et)�FF77T5830%119919x3/y�9}�(6G1?�R�1%I?�B;F,777 � GENPRATQR'SINITIALCOPY <br /> z <br /> JASON GAITAN, REHS Page 34 of 34 <br />