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3460 Naglee Rd. Record ID# PR0527345 <br /> 11/20/2020 Program: HW <br /> Photo 37: The following uniform hazardous waste manifest (0 1 8170049JJK) observed with a designated facility copy. <br /> Fteglertri,int or type �ry <br /> . <br /> Z 3 a ..l -7 SLI 4�I Faml Approved.0108 No 2n50A03g <br /> rINIFORMHAZARDOU5 I.CenernloriO Nvmber CRLD0045@7R1 z Page o! a,Emu gp.es ePApPn�a •,Man+hns TracNlnB Nam <br /> WASTE MANIFEST 1 4 1 1-46 <br /> SK <br /> 5.GeneraX]Ie Name end Mailing Addmsa GeneraloYs eure Address of diReeM Pun mailmg add2ssl - <br /> Platinu■ Hyundai ❑f Tracy <br /> 34$0 Naglee Rd <br /> TRACY Cn 95304-0000 <br /> G—tins,,".Pna,a,. 209-309-3181 <br /> s Trpgrpy(prlCompanvldama SYSTEMS INC US EPA1D Namder T1(R0000B120� <br /> 1 Tranepater 2 ComPan�YNemo U s EPA ID Number <br /> CLEAN HAR80RS ENV SVC INC. MAD039.2225P <br /> s Desionaled Feoliy Name and SWAM— CLEAN HARBORS EL DORADO, LLC LS EPA ID Number <br /> 309 AMERICAN CIRCLE <br /> 870–E63-7173 <br /> EL DORADO , AR 7173e <br /> ARD06974819� <br /> Farllr's Pnone <br /> 91,U S DOT Desrnptlan(including Proper Shippug Nam Hazard Class,ID Number. 10 11 Total 12 Una 13.Well Cadens <br /> HM and Packing Group plari xo Type a—Ity Wrlvol. <br /> X 1. RD UN1950 WASTE AEROSOLS (EACH NOT Dh 'oa P D0@ DI Q006 <br /> o EREEDING I L CAPACITY), 2.1 (0001) <br /> � Q00 D0@8 331 <br /> z z. <br /> r <br /> a <br /> 14 Speaal Handbng lnsimcions end Addmonal lnlumisaan TSID-EL X2276246 PLIS815CS4�� , <br /> 1)ERGi1126• � UUQC , <br /> 24H EMERG9NCY#IB00-4b9-1760-CH/SK/TF I-Contract retained by generator confers aggency autnari y <br /> on initial transporter to add Or substitute additional trans orters on eneratOr+s behalf. <br /> 15. GENERATOR'SlOFFEROR'SCERTIFICATION:Iherehy declare vat the cpnlanladmis wnsignment are filly and acryutely aeaalUed amus by the proper shippir+g name,amare classrfMd,packaged, <br /> marked end laheledrplac-andad,and are in all resyecrs In proper condT,on for aanapon according In applicable intema6onal and na aortal govemmenla!regulacons.Il elrpon slspmentand I amtha Primary <br /> Erpader,lcerafy Nat lha wnlanLsdthis consignment mnfamWlheterms oPthe attached EPA,uknowletlgment mrsent <br /> I ceraly Net the wasle minimization statement identil iri CFR 211227(a)(,I l am a large quanmy generalgry IbI RI ma small pulainertg tarps due, — <br /> Genera 1 67nn1ed?ypetlN e y Sgnatu _ Muth Day Year <br /> T to <br /> IG.Ince dopa$Prplrkran �� <br /> F. ❑Import is U.S. ❑Expan fiam U.S. Portal <br /> ? TmnWWerslgnaluro{forexportsonly). <br /> Oaleleaving U.S. <br /> w IY.TansponergcXnowledgmenl ofRecelpt of Malenala <br /> I's Trans ner I PnnteNTyyed Name Signal. Month Day veal <br /> 0 <br /> a <br /> Z Trans Pdnlecrypetl a Signature <br /> c Monty Day Year <br /> I Crepancy 11 <br /> 18X,(jiscrepanry IlMlmnon Spew <br /> ❑oventlly ❑Tyre ❑Residua ❑Pareal Rejection ❑PUT ReieChon <br /> Manitast Reference Number: <br /> 18n,Wlemale Fardlily(pr Cenerel.r) U.S.EPA 16 Number <br /> U <br /> LL <br /> Fal Phone <br /> w 18c.51gnatureol Ahemalo Faalay for Gone—j <br /> Mwh Day Year <br /> z <br /> c19 Hazarrl W sM Reiw Management Method Codas(l.o_codas for hazardouswasle treatment,disposal,and recyoing symar l <br /> 20. a lienar or Operator:CsrtillcrIkiral receipt 01 hazardous matenals Caned Dy the manifest exmpl 8encled in Item 18a <br /> Prii iedll Me S+gnaWre <br /> r A1oHln Lal srir <br /> EPA Form B7 22 ev 12-17�I Previous edfGGns are obsolete. � <br /> 1)8767 6 /1 9527 1! DESIGNATED FACILITY TO GENERATOR <br /> JASON GAITAN, REHS Page 37 of 51 <br />