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3460 Naglee Rd. Record ID# PR0527345 <br /> 11/20/2020 Program: HW <br /> Photo 22: The following uniform hazardous waste manifest I1817004 lacking a designated facility copy. <br /> amltlugnetl torose on slim 12 Ide ter. Form Apprmed.OMB No.2050-0039 <br /> T�EMAIIT <br /> RM HAZ4R000S T Gmeremrlp N'rmpe' a.Page 1 0l 3.Emarg�q ReSpnrt'e Plwne M((it�llattTncklne Number <br /> STE MANfFEST �/�uCAI PQflT n Fro(/F <br /> Saf <br /> �nM T TU LW OF TRACY-NRC14G m ll eamess)480 71ILEE ROADRACYCA 95304 <br /> rd Ph", X8210,3550NsnraYppWrRtc�P1n1�ENNRONMENTAL SFRVlf,E9 r,A G O_flORLOWIUE RFCAVl SY:T CM INC v.s.EPA to NumerI:AHUOr�I <br /> uled' Neme ervi 511eAdd— US.EPA 19 Number9 I�QEME00 U3 HIGHWAY 95 <br /> W AZ B.S.'iCs_4yRrl i-1 1110, <br /> Phme (98)b,0.S.DOT Usami ficial g Proper Shipplrg Name.Ha d Class.lO Number. Ianmners 11.Totalnd PaGklrg Gr 0athye No. TYPa Ouars1j WI NO <br /> a 1NON RCRA I"I'Mil U;WRSTIF SOLID if PAPER FILTERS; <br /> o <br /> a <br /> s <br /> 3. <br /> t <br /> 14 5oeuiar Handling Imlivil wu and AdtlitahaI lnfommtlan <br /> ENCYCONTACT-CHEVIll 1.8064?4.9300 WICE5 TERMINAL <br /> 162623NRSPRE146 PAPER FILTERS" •APPROPRIATE PPE EQUIPMENT <br /> t <br /> t5. GENERATOR'alOFFEROR'S CERTIFICATION I hereby dectare Hha[the contents of mis rbnsignment are iulry aM acrvmmly desumed above try era proper shipping name,a1d ase doomed.packaged, <br /> madredaM IabeVeNpla[arded,and are rn all re5peC15 in proper COMNon lot VdnSpeR aoceMing to apphraWe Inmmational and natior'al govemmenlaV regulations,if eapod shnpmenl arhd I am the Pnmary <br /> Exporter.I mrd(y that the conrenls of this consignment conform to the terns of the attached EPAAckncwledgment of Consent. <br /> I certiry;hal ma waste minimhzalan stammenl laen6aad in 40 GFP 262-27(el{if am.large gwntlly generatarl or tat ftl am a small quamrtyganerelwlis true <br /> G...ralprSiodemfs Annfedrrypad Name I Signature Month gay Y., et, <br /> me <br /> ata <br /> 1b,InlBmaheoal Shipments <br /> � fmpad W U.S. ❑Exltpd from U.S. Pod M eneyfexil _ <br /> Transpoder sgnature(for exports onlyl' Oats leaving U.S.. u <br /> f7 Tianspeder Ackwwfedgmenl of Receipt of Matenals ,nee1 <br /> Transposer 1 PdnledRyprd Name Signatate Month Oay Year .lees <br /> O ' <br /> N <br /> aMI Transporter2 PrnledQyped Name Signature Month gay Peat herr <br /> ♦ fB.Discrepancy <br /> 1JII 188 01sr1epa rylntli shoo Space Quantity ❑Typ ❑Residue ❑Pact.;Re}ecnon ❑fu11Re}ecflon 7 <br /> all Relerl Number'. <br /> 181.Altemate Facility{or Generator) U.S.EPA 10 Number <br /> _J )IL.INC <br /> U SSE f•A <br /> uQ. Facllily's Phone', 4 <br /> w 18c.Si9nawre ofAllemate Faci(or Genemlor) 1danN Oay Year <br /> ZZ <br /> 19.Hazardous Waste Report Management Method Codes li.e.,codes lot hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 2. -2a1e1 <br /> Co <br /> 20,Designated Facility Owner or Operator.Co1lim4ien cr receipt of hazardous materials covered by the ri lest except as noted in Item 118ia <br /> PrinleNfyped Name signature Monti ay Yea; <br /> EPA Farm 8700.22(Rev.3.05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 22 of 51 <br />