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3460 Naglee Rd. Record ID# PR0527345 <br /> 11/20/2020 Program: HW <br /> Photo 35: The following uniform hazardous waste manifest(007314648SKS) lacking a designated facility copy. <br /> .7 Please Print or type. :-(- ) -7 ..7_'1I ` <br /> Farm ApproveU.OMO No 2650A639 <br /> UNIFORM HAZARDOUS I�^erabrrO Nwnber CAL000450781 2Pagol or 3EmsM-11espppge Pl�mp,� 4.Manila Tracking Nump¢. <br /> wASTE MANIFEST l 1 t!c'Nb 415 1 rE� SK <br /> S.Genere[c(a Name--Mdllmg AEdress —.1—Srle Mtlrr551�l d�flarenl Nan m".'aadressl SKS <br /> PietiTIUD Hyundai 1)f Tracy <br /> TRACY CA <br /> R4 <br /> CA 95304-0000 <br /> r r­mrevna,e. 209-309-3181 <br /> e rr�u rt�m�y SYSTEMS INC U.S.EPA IO Numua. T%R000rB81205 <br /> 7 Trensppnpr2 Gompa�n�99 NamB U.5 EPA Number <br /> CLEAN HARBORS ENV SVC INC. MgU39322250 <br /> e.D-o-id Paolify Name and Sde A88raas CLEAN HARBORS EL DORADO* LLC us EPAIDNulnber <br /> 309 AMERICAN CIRCLE <br /> Facndy s Phone FL DORADO , AR 71730 <br /> • 870-863-7173 119D059748192 <br /> as 9b.U.S.DOT DesrriPuan nmeer 51,pping Name.H—d Clan,10 Number, 10.Cwnainen 11 Told 12 Unit+rM end Paclting Group(Ifanyl) Ne Type gaantfly wl Nat 13 waste Codes <br /> k ' RR LIN1958, WASTE AEROSOLS, PERCH NOT TimP 1700 Q0¢5 D005 <br /> 0 EMEEDIN6 1 L CAPACITY), 2.1 IQ1D01) Jfjt} <br /> Z r D00 00(A 331 <br /> Z_ 2 <br /> le special HandlinglnswcuaUsaneaddihonalmkrmaaon ;SQ�EI 82276248 PLIS816 <br /> I)ERG#126 <br /> 4H EAmERG&CY#800-468-1760-C)i/SHITFI-Contra <br /> ct retained by generator confers agency author, <br /> ren initia tra s Drier add D su itut a d't" =toy, <br /> rs en ratnres uth <br /> t5 GEN FRATOR'SIOFFERCR'S CERTIFICATION:I herabydedarethat the canlents of this wnsignmenta,e wily and aC..lelydeacnbad above by the propershrppug name,ard are Wswfletl,padtaged. <br /> madrea antl IdbeleNpldC8lded,and e+e in ail respells in proper wrtdlllon ipr lraaspod BKArtllnq 10 applicable fnremabenaland nahendl g0Y¢mmanlal regulabpn�if upon snipmenl IndI dmlhe Pn <br /> Evpoder, certify tify That the conlerrls of this wnsrgnment conform N the terms of the afta&,d EPAAckrwwledgmenl of Consent. mart' <br /> I wdAy mauhe wash minimizahon sratemen[itlenuAed m aO CFR 262.27(a)til l am a large quanuty generamq of(bi(ill am a small geansty getierawrlw Wa. <br /> Generatols'Qaemfs PrinledRyped Name Signature Mon% Day Year <br /> T6.Ihremabnnal shi <br /> pm¢n[s �Q <br /> z ❑Import Ip U S ❑Erpon from U.S. Port of enityl6dL <br /> TMSPoner signature(fo,uports only): <br /> !r 17 Tra Dale leaving U.S.: <br /> � nsponerAcknoxgedgmenl of Receipt of Materials <br /> Tran ntf i Pnnleyrypad Name Signaw <br /> O f MW% Day Year <br /> z Transposer 2 PrlrW"yped name Y- y SignaNla �' I ' <br /> Month I ay Year <br /> r <br /> 18.Discrepancy <br /> laa.Discrepancy Indje lion Spare Quanhry E Typo ❑Residue ❑Penial Relecbon ❑full Reiechon <br /> 18b.Altemale Facirily far Genaralcf) Manifagl Relarenrs NOmbar <br /> Z:i 1J.6 EPA ID Number <br /> U <br /> LL Faddys Phone.- <br /> 0 lac.Signature of Ailemafe Faallty for Generator) <br /> Q Manch OaY Year <br /> z <br /> Z5 19.Hazardous Wasle Repun Management Method Codes(10.,codes for hu"ous waste Irealmenl,disposal,and r gUIng systems) <br /> 1 2 3 a <br /> 20.Deslgaalod Facilely ONneror Operator:CedlIcation of rowipl of hazardous materials wver(d by 1110 manirest ayoepl as hided In Ilere lea <br /> Pantedlryped Name Signature <br /> Month Day Yoar <br /> %j)`p q ious editions are obsolete. <br /> 7 1�.� GENEftATOR'51N1T4AL COPY <br /> JASON GAITAN, REHS Page 35 of 51 <br />