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3460 Naglee Rd. Record ID# PR0527345 <br /> 11/20/2020 Program: HW <br /> Photo 26: The following uniform hazardous waste manifest(016870312JJK) lacking a designated facility copy. <br /> Sir <br /> Please pmlt or type.(Form devgned for use on erxe{I2yrdh)ypemua I Folin Approved.OMB No.2050-0039 <br /> UNIFORM HAZAROGUS a �a�rtlMn4w 2.Pageld 3Erteigercy Rewmse Phan 1Manlhst T.mkingNumMr <br /> tWAylWEE�M�ANNrIIFESTx.rg•AEr}On3R,r,0�� , ,.r,,.. 41U87Q312 JJK <br /> s PNEIYIIER HYdU�IlM1 OF[RACY FIRE1gp rti'.rswr'sa'earu is aaerml>r nmuleq sod`ssl <br /> S4W NAIGtEE ROW <br /> ?RACY r:d1 EH.3p4 <br /> C>�NYbh Pryku' JOD a2TA WW <br /> V 5.EPA3O NumLar <br /> 2 T 7 0 <br /> us.EPA IO N <br /> e Trr.rpaW1�OIL EN FFH?rrMENrAL OFRYIf,£� ':n l?o.N <br /> 1_T WWidupulerZ FYrm I <br /> WONLDWIb RECQVERY 9'r:7 FM INt- f.A P(10 01 1 A: <br /> a FtllryMe..0 SAeAdbsy U.S-EPAIONemner <br /> MANAGEMENT INC <br /> 915001!,9 HIGHWAY 95 <br /> YUMA A2 k63G6 AZRUD052114E, <br /> Fad Panne. (0291344 9829 <br /> % Ob U S.OOTOu Vw rin"PmW Wpo g Nemo,Hazed elaas.lo wM1 w. la.Cmeanen li jT ho 12.UrA <br /> HM Md Pod'hec-WN o r No T, Qu'allkty MM 13.Vheh Cotler <br /> N'.)N IMRA rWARDGU's WA_.TF `.OIIL)I'rll t",,Wi PAPFRFH-rEP51 <br /> - � I <br /> z <br /> 3. <br /> d, <br /> Id.Special Handilrg Insaudions and Addeo u!Inlarmabon <br /> r.fr.GRGENCY CONTACT CHEMTRF.0 .1 R90424 R:70t,WOOS TERMINAL URES cS •PF)k!LE 0 3B1 1626.23NRSPRE346 <br /> -rrl Y 90L11D PAPER FILTERS• "APPIROPRIATF PY:'EQUIPMENT <br /> t5. GENERATOR'SrOFFEROR'SCER7IRCATION:Iharady declare that the mnlenls or Nis amsignmenl are lwlyaM acars4ery desaiUed aUove by Na propenSMpgng name,a tare dassdiad,nackagad, <br /> marked and labaleb'prararded,antl arc in all respects in proper condlGon for eanspdt eamrdrng to appy'rcalde mtematlonal and national gavemmental regulation.II eapod shipment and 1 am Ih0 Pnmary <br /> EaPoda'.IceMNthat Nemnlentsorthis cenignment corfom 0 theleansoft"an Ihed CPAArlrnmaledg—rk ofr,n nt. <br /> I e9r*y",Hhewaste—r—b.sbtemenl identified in 40 CFR 2e2.21(a))dl am a large quantity genndo,)or(b1(d 1 am asmall quxnany gereratnr},s bue. <br /> Cenel3torslDY9rues Phmed7yped Name Signalure Month Gay Year <br /> F <br /> 16.Inlemaannai Sbrpmenls <br /> LI port to U.S. ❑E.Wa hon U.S. Pon ofenmyN k <br /> Z TrenWar signalure(W eapads mly) - Gate leaving U.S: <br /> w 17 7ranspaderAcknoeiedgmentol Recalptnt Matelots <br /> T2nspdrter 1 PdnletlfTypetl Name SignaWre Monro Cay Year <br /> O <br /> a <br /> 4 Transpoder2 PrinleNTyped Na- 5lgnatum f7.nn1h Day Year <br /> D.ecrapancy <br /> 11 18a.Giscrepancy lndh lmn Spa. C—Uty ❑Type ❑RaMi ❑PaNa4Rejacbon ❑Putt Rete wn <br /> Mani Reference Number. <br /> 186.Alienate Facility(or Ganeralor) U.S.EPAI9 Number <br /> J <br /> U <br /> r4i Fadlityvs Phone, <br /> 18c Signature olAlterri Facildy(or Generator) Month gay Year <br /> 4 <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(I e,nodes for hazardous waste treatment.disposal,and recycling systems) <br /> 20.Designated Facility Owner or Operator Cartifica8on or recaipl of hazardous materials covered by the mandest except as need in Item 18a <br /> PnnledTyped Name Slgnalwe Mai Ila, Maar <br /> EPA Fom187M22(Rev.M5)Previous editions are obsolete. GENERATOR'S HT1AL COPY <br /> JASON GAITAN, REHS Page 26 of 51 <br />