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3460 Naglee Rd. Record ID# PR0527345 <br /> 11/20/2020 Program: HW <br /> Photo 28: The following uniform hazardous waste manifest(0 1 8526708JJK) lacking a designated facility copy. <br /> Please pdnl of 9me.(Fpmn tlesipnad far use Al slim t1211,1ch typewnmr I Fmm Appmvad.OMB Na.2050-0079 <br /> UNIFOflM HA2ARp003 a'diB^a ID NwNyr Z.Pape 1 or 3.Emergency Response R+O�ia 1,Renrmet Tnckmg Nombnr_ <br /> WASTE 1wANIFEST 171111 185005 T r=.:�,.n•rt yu.a. �1t� is.V. _ JJK <br /> 3480 sG 48,PERl7YUN���mpv�n1a Den.nw,s;>s eear.sa lrtameranE sen ree�r�men�l <br /> W OF TPACY�PRET49 <br /> TRACY CA <br /> ROAD <br /> Gelxranre Ph— <br /> 204 N2(}3550 05,9114 <br /> 6.manapIXee 1 Dmrye Neme <br /> WORIb OIL EIYVIRONMERTM 9ERyICE9 us EPA10 Ramsar <br /> CRO026_7 7u16 <br /> 7.Tnnepe2Car,a Rama U.s,EPAIp Nwrgy <br /> WCiR E <br /> LDWIQREf.OVERT SYSTEM INC <br /> CAR000176422 <br /> a.pealpnated Federy Name and Sim Aadma9 U.S.EPAIV Nur,ber <br /> YE$AMNAGFMENT INC <br /> 1 US HIGHWAY 95 <br /> M <br /> AZ RfiWF <br /> Fadli s Ph... (9711 104-9822 1 <br /> A 2 R 0 0 0 S 21.1 4 6 <br /> 9s. 9d.U.S.OOT nega,p n(injn,g Pmper Shfti,ra Name,H—d Class,ID Number, 1p.C.G— <br /> HN and Paddng Grove(p any)) 11,Tmak 57,Vntt ta.wears Cadea <br /> Na, Type �uarpry WI.NN. <br /> o NON-IRST <br /> CRA HAZARDOUS WASTE;OLID(PAPER FILTERS) <br /> Q <br /> w <br /> W z <br /> c� <br /> 3 <br /> 4, <br /> 74.Spedal Handling Iashuti and Addidpnal Informalon <br /> EMERGENCY CONTACT CNFMTRFC 1-800.4211-9300 W4ER TERMINAL'CERES CS 'PROFILE d 9111 16262311RSPREI4R <br /> PAPER FTITFRS" APPROPRIATE PPE EQUIPMFNT <br /> 15. GFNEAATOR'SIOFFEROR'SCERTIFICATION:Iherepy declare lMt Vie ContefltldNile wnsignmenl are fully and auurately de5Cri6ed above 7y the pines,shipping natrle,artl a[B da55Etotl.pxkaged. <br /> maftd and labOedyplacarded,and are in wP nespeom In proper—diann lar lranspW according m appl"Ne inlemabmaland national g%emmental,og,kabu v.h eapon shipment and I am the Pnmaiy <br /> FXPpnar,Icerti mal Ne mnarns of this cpnaW-1 wrifi-i to the EBrma of the aaadmd EPAACkvwWgment Y Ca—M <br /> I.15ty that the waste minimisation stam,rcenlidenetied in 40 CFR 262.27(a)laI am a Ialgequantaygeneakv}m Ib)ffi am—11 quannly generator)Is tine. <br /> Geteratoe.(Ofl mors Printed/Typed Name Sl.%,e Morar pay Yea, <br /> J IS.Inlematipnal Shipments E]Impod to U.S. ❑upplt fnpm U.S. P0rt0renhyreul: <br /> r <br /> = TranNa rtes signatare(for exp*ds wly): _ Dale I—Og U.5: <br /> -1V T.,qW$,AdMWMgmenlotRemhpto(Mabmials <br /> K Transporter 1 Pnmed/Typed Name ` Signature Manlh Day Year <br /> O <br /> TrapsppNer2PdnrrdRyped Name ftmiWes Monkh DaV Year <br /> Ge <br /> r <br /> 1a DmaapancY <br /> 18a.Dlaaepancyfrldeadonsp ee ❑Cuanllty �rypa ❑Resldua ❑Pa"I piodon ❑Fun Refection <br /> ManHesl Reference Number <br /> 78bAasmwt Facdlly(a Genemor) US,EPA1DNumbet <br /> J <br /> fa <br /> w Fabhty's Phare. <br /> w Isc.Signavis ofAllernata Facilily(Or GenpmIcF) Mon1n Day Year <br /> 4 , <br /> S <br /> 19.Hazardous Wasle Report Managamanl Malhod Codes(Ie,codes for hexardous waste Realment,disposal,amt iecycling systems} <br /> O 1 A, <br /> 211.Dealgnaled FaciGly 0 yner Or Operelur.C,11c'ion of recelpl of hazardous melenals Dovered by the manifesteacept as nated in Ilem ISa <br /> PnntedfTyped Name Slgnalufa Month ➢aY Year <br /> EPA Farm 8700.22(Rev 3-05) Previous edimns are C6salete. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 28 of 51 <br />