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3460 Naglee Rd. Record ID# PR0527345 <br /> 11/20/2020 Program: HW <br /> Photo 23: The following uniform hazardous waste manifest (007314647SKS) lacking a designated facility copy. <br /> '99L 9K SHIPA 23a7.a?,30N5 / <br /> Please Annt or type. " i Forcn Approved.CM9 No 20500039 <br /> UNIFORM HAZARDOUS ''G.e W,'D Namber e.Pape of a�a�y R ase P /.Manned Y*acking Namb,r <br /> WASTE MANIFEST CAL001D4507B1 1—tl �— bb— Q 007314647 SKS <br /> 5�.emralo/5Name antl Meheg A44mae GenerEIVe Sde MU-lir darereetthan-1111 address) <br /> platinur Hyundal Of Tracy <br /> iRACYNa9 Re Rd <br /> r;aeeralwa l�r�- <br /> 209-309-3101 LR 95304-0000 <br /> P <br /> s,T`wI lare R SYSTEMS INC uSEPA ICNember T%R0000B120" <br /> Tra Krin 2 company Name US.EPA IC Numbe' <br /> CLEAN HARBORS ENV SVC IN(_'. MRD039322G�'. <br /> aCesrgnatad FeUnty Nemo end sae Atlamsa CLEAN HARBORS SAN JOSE US PPA IDNamla!r <br /> L021 BERRY£SSA ROAD <br /> 408-445-0952 SAN JOSE CA 95133 7ADeS9494340 <br /> Facbys Poona. <br /> ga. 9h.US DOT Deacnpbon liecwdeg Proper Shipping Na-Ha M Cia55,ID Namher, 10.Conra­ 11.7oW1 12.Una 13.Wada Lotles <br /> HM a^R Gr«+PGranvll No type Ceamlhy Wuaa. <br /> 1 NON RCRA HAnRi)OU5 WASTE SOLIDS OM 0 P 223 <br /> 0 4Al'15C}RBENTS CONTAMINATED WITH OIL), a�,- <br /> z 7 NON�RCRA HAZARvous WASTE SOLID RM r11 v P�_3 <br /> SOIL FILTERS) ' 1 <br /> l <br /> r <br /> a <br /> is spuealxandlblglnalraalr«teararadmanalmformanon TSD.8.7 92276248 PL-15815 <br /> 24H GMERf3FNCYit22g-468-'1760—CH/SK/TFI--Contract retained by generator confers agency authorT <br /> on initial trans Otter to add or substitute additional trans otters on coats ors behalf. <br /> F5. GENERATOWGIOFPEROR'$CERTInCATION:Thereby tleclare loaf the Cwtlenrs althls[Onsignmenl are tally and arlurakly aesoibed above by lite proper 5nrypinq name,artl are 4as5d`aa.patica9ad <br /> markedantl Ia WledlplawNe1,antl 11 11111 respects 11 proper-1111pla eansporhaaadin9w apgireble inlemaGonal and national governmental regvlaGgns.If export shipment antlIam Ina Primary <br /> Exwrler,I rlify Nat the ypnlenfa of this w-gnmenl corfo totheharmsofrheatbchedEPAAcknowledgmenlofConsenl <br /> - <br /> Icarbfythatthewaste m rorniaalion ala[amenl iden0edN 40 L FR 267.27(x)(41 oma Wig,quantity 9enonoUw(h)hit t arca small gaantnpg Eratpr)mtNa. <br /> Generalors1011emfs PnntedRypgtl Nama Sgnawre.- Miannie Dey Year <br /> Ib.Iniernaaonal ShrAmenfs <br /> � ❑Impart to U.S. ❑Expan lrwn U.S PadMcMrylaxit <br /> ? Transporter erg..-(for expaM only): Date Ieavmg US <br /> W 17 Transporter Acknowredgmenl d Rereipl d Materials <br /> Tra rter++I,,1Pn�nyretll/TA�'�a�d`pNayme Sign UI Month Dayq Y-1 <br /> AEav <br /> Z Transporter2 PrinlstlrTypetl Name SignaEure Month Day Year <br /> r <br /> a 78 P�sc+ePancy <br /> +Illi .da.Olscrepancy lndicaGon SpaceLl uan <br /> qtity Typo ❑ResMua ❑Pamal Re)acbon ❑Fu1VAe�ection <br /> Manr lesl RBWranca Number <br /> 18h.Altamaha Facility{pr Generator) U.G EPA ID Number <br /> J' <br /> U <br /> tai Fachilys Phone', <br /> kpu 18c.Sgnature ofAltemale Facility(or Genelalor) Month Day Year - <br /> 4 <br /> 2 <br /> w1 p Hazaftlpus Waste Reppd Management Method Cedes{ie,CndBS for hazardous waste trealmenk,dlsposaV.antl reeyding system) r <br /> 0 1 2. <br /> 1rI 20.Designaled Faciiity Owner or Opefalor.Cedlfi�l ttn of meeipl pf haialCpNe maledale Covered by the manilesl except as tided in Item 16a l <br /> f PrmletUlyped Name Signatwe Mon(h Day Vear S <br /> I EPJlorm700Rev.g52PrgI1usltFg�rrjt1e1:5GENERATOR'S 1NMALCOPY <br /> 75 <br /> Name 20161 <br /> JASON GAITAN, REHS Page 23 of 51 <br />