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3460 Naglee Rd. Record ID# PR0527345 <br /> 11/20/2020 Program: HW <br /> Photo 29: The following uniform hazardous waste manifest (0 1 8531276JJK) lacking a designated facility copy. <br /> plaese Print a IyPe.irorm easonea for use on ere(I2-pNdu Iypawnter) Tft <br /> id OMB No.20501 <br /> FORM HAZAU0115 ue2 PageaofaEm¢rge ykeafaarne Ph . f� {(FST rrr,�-r,:..l-r�.r„ 76 JJ„ <br /> S Genenror'a Name ane Manana weress Cenenrere Site a1dreu til EiRercR Nan meianq aaar.ea} <br /> Geaanni tTem' - <br /> A rniapmlarl CompeaY Name LI.s.EPA IO Nrmtwr <br /> WONT D OII EMY1rMNMFNTAI'rNY1r,i CAU 0:A:T 1 0 3 l; <br /> 1.Tr.napener2 curroenv Name u 5,E,_ Numaer <br /> e.peagrer.a F.aty Name and ii Matteis Us.EPA ID Non,e, <br /> YES MANAGEMENT.INC <br /> 6900 US HIGHWAY d0 <br /> CA r153u5 At R0 Uii!..'] t <br /> Farm Phcna 19781344 5grfi <br /> pp. Bb.V.s.ODT Pesraptlon <br /> }1 Oradi proper SrilppAq Nana.lSrread class,10 NrmaType <br /> er, 1d.Conlaiaem 11.7otel t2.Una <br /> NM cid Pachlrg 6mup 11[amy0 la_w as codes <br /> Na. uarMy WlNd. <br /> C INfyN-RC}7A L;AZAPDOUS WASTE.:,0LIU f0f1 Y 70HD PAPER FILTFFT.^-} li M r <br /> �q d. <br /> to 2 <br /> to <br /> 3. <br /> 4. <br /> I <br /> 14.$Pedal Hantlkrg Instructions aadAddiaonal Inlonei <br /> EMERflENCY CONTACT CHEIVIl 1-9()1D-424.g3G0 WOES TERMINAL --E'-FILE Of-I rr:'PE CFP1r,, -.,-t_0I01,11AL F - <br /> CODES 881._NONE*APPROPMATF.PERSONAL PROTECT;YF.EQUIPMENT <br /> 15. GENERATOR'11011E12' <br /> 8 <br /> CERTIFICATHIN:thereby aedare mal the mntents armis mnsgnmem are forty aM aaumlely tlescnoetl abovaWthe proper shippiy name.aN are daurfred.packaged, <br /> markedand lAtItdlplacarded,antl are in all respects,in proper condition I.transport according to applicable intemabonal and national 9memmareal reVernns-If eaporl swarmatel and am the Primary <br /> Ekirmar,--Friary that the rnnlenfs of rote mnsignmanl mnmml to the terms of the atta w EPAAk—ledgment a Consent <br /> Iramifythat the waste miniimaation sielani idea ied in 40 CFR 2e227(a)(if 1 am a large quantify9enem0or}of i iI am a small quaaa!y genorei Is cora. <br /> GeneraWyOrterors Pnna:drryped Name Signature Month tray Year <br /> F18.lntamafiasal Shipments ElImportio U.g- s <br /> a ❑EapoRirom u.s, Port of anityleat <br /> Transporter signaana(Por exports only;: Gale leaving of S <br /> 17.Transporter Acknowleogmenl o!Receipl of Malerias <br /> Transporter 1 Pdnledfryped Name Signaaae Monro Day 'fear <br /> n <br /> a Tmnsporler2 PPnledrtyped Name 5lgrukne Month gay Year <br /> aY <br /> H <br /> T 16.Ulscrepancy <br /> full Ida.Aiscreparr y Indication Stance ❑OuanWy ❑Type ❑Residue ❑Psrual Relecaan ❑Full Raxt. <br /> Manifest Reference,Number <br /> 196.ANemalo Facility tor Generator) Manifest <br /> S.EPA ID Numhar <br /> ds <br /> LL FapifitYa Phone' <br /> w 18c.Signalum olWlemate Facility(or Generator} Month ➢ay Year <br /> a <br /> z <br /> 0 19.Hazardous Waste Reporl Management Method Codes(i.o codes for hazardouswasta treatment.disposal,and recyehng systems <br /> W <br /> 0 <br /> 20.Desigiri Fai OaTi Operator:Cerlt6calion of receipt u!hazardous materials coveted by the manifest except as mated m Item 16a <br /> Pdnted7yped Name 5igni i Day Year <br /> EPA Form 87OC-22(Rev.3-05)Previous edtions are obsolete, GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 29 of 51 <br />