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3460 Naglee Rd. Record ID# PR0527345 <br /> 11/20/2020 Program: HW <br /> Photo 25: The following uniform hazardous waste manifest(016868632JJK) lacking a designated facility copy. <br /> �IXr Plea l or t _Farm designed br b5e nn aNle{Iz-prtUi)fYPawnter I <br /> �-eC se Ann Ype( FOIm Approved.OMB Na.2050-0634 <br /> UNIFORM HAZAR 0 <br /> 0 <br /> U9 crn¢gId lD Number e.Pageergemy Reaparea lor e.EmPhwie a.Manifen Tracking Number <br /> FDI WASTE MANTEST rl U O 3 R rr r1 r! r';rlpl q_N•J.ir� YJK <br /> 552 5.GPREMINVX41 leiiuignatlr¢aa GenembrsSM Adtlmss{atldlerenl Nan mating address) - ` <br /> ."soER h'YE RGAI OT IIrACY ANE LIR <br /> :51110 fVAGLEE ROAD <br /> (RACY CA 95340 <br /> ce loespnonr 309820.3b50 �1 <br /> B.Tno a de 1 cPr y Name U.S.EPA ID Number 4 <br /> WONTD UIL ENVIRONMENTAL SFRYlCF9 C A G O::e:1 <br /> T,TraAvom 2 C,,mnany Nan' US,EFA IO Nainber <br /> n WORLOWfDE RECOVERY SYSTFM INF- C A F1 D 1 T.112 2 <br /> r A Desgrletea Fadlp Nama el4 W.Agtlmaa US.FAA ID Number <br /> YFS M W 0FMENT INC <br /> 6600 US HIGHWAY 35 <br /> f PUMA AZ IR5365 AzR0005211de <br /> Fad a Phone. q^ q A' <br /> tie So 11 <br /> 00T Dasuplmr(mudi <br /> dng Proper Shippwg Name.heard Clm.ID Number. le.Conuimae 11.7da1 12-unit 13.waste Coatis <br /> T HM andP i'ngGMP(Harryl) No TYPa Ouantily OhA". <br /> 140N-RCRA HAZARWUS WASTE SOLID{(MLY SOt ID PAPER FK TERS7 <br /> 0 <br /> f 2 <br /> I �7 <br /> 3 <br /> 4. <br /> 14_SPepal Handling Inswmansand Additional Imooimaaon <br /> r MER'ENCY CONTACT'CHEMTREC 1-800124-SUO Yll TERMINAL.CERES CS `PROFILE M 9R1 592E23NRSPREI417, <br /> ,1°i SOLID PAPER FILTERS` -APPROPRMTE PPE EQUIPMENT <br /> 15. GENERATOR'slprFERGR'S CERTIFICATION-thereby dedare Nal the motantu of Nis consignment are fully and ararataly desoibed above byte proper shipping name,and are dassifiad,padrWed, <br /> marked and labeh drptatarded,and are In aN respecls.proper condition Wt wWort amordin Ig applicable intemal4natand national ggvemmental mgulatlons.R axpod 0ipmem and 1 am the Pnmary <br /> Emoder.I oeriify that the oonlenrs of Nie Conslgnmem­form tu Ne terms of the a ft erred EPAAdlnavkdgmgrtt of Consent. <br /> I[arty Vol the waste minimizatlwl statement Menabed in 40 CFR 11111,1)1TI em a large quantify generator)cr(b)(ifI am a...If qu hly generator)g Nue. <br /> C>Q .lor.V1 mes PonfdTyped Name Signatum "n11 Gay I Yaar <br /> 16.intemaeonal bhipmenls <br /> r ❑Import to U.S. ❑Fxportirom U.S. POM1of entrylexil: <br /> Transposer signature P,erpom Mly) Date teaw+g L.S.: <br /> 17 TmnsporferAdvmwledgrrxml Pf Receipt ofM."e <br /> cc Tmn�P­IadfTypd <br /> Na" Signature Monln D Year <br /> ay <br /> d <br /> N <br /> G TmnsName Signature <br /> Month Day Year <br /> rc <br /> r <br /> :p 19.D&.1)=Y <br /> 1 lea.Discrepancy indication Spare <br /> ❑tluanSty Type ❑Basque ❑Pattial Releclron ❑Fu4Rejec4on <br /> Manifest Reference Number <br /> }Bb.Aflemals Faciirry(or Genemfar) U.S.EPA IG Number <br /> J <br /> U <br /> rat Facility's Phone: <br /> 18c-Slgoatumufftmale FEdhty(or Genemlor) Month Day Year <br /> a <br /> z <br /> H19.Hazardous Wasle Report Management Method Codes(l.e.,oufas lorhazardaus waste trealmanl,disposal,and reoycling systems) <br /> W <br /> Q <br /> 20.I)esignaled Facility Owner lar OperatorCerrifimttnn of reCelpl Of hazardous maledals mvemd by the manliest excepl as noted in Item 18a <br /> PdnfaVypedName Signalune Month day Year <br /> EPA Form 8700-22(Rev.3-05)Previous editions are obsclete. GENERATOR'S INITIAL COPY j <br /> JASON GAITAN, REHS Page 25 of 51 <br />