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1403 West Country Club Blvd. PR0521815
<br /> March 29, 2022 Program: HW
<br /> PHOTO 1: Manifest found without a desi nated facilit si ned co
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<br /> STE MANIFEST C A L 0 0 0 4 0 7 0 2 6 I.Pryaet 3.Emxgerey l2eappwapFpre Fpm .OM9 No.20`ALOe9
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<br /> JJKiVER STREET
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<br /> UNTTRy CLUB BLVD
<br /> STOCXTON CA 96204
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<br /> /,Q6� AC;gLIFORNIA MEXICO GP21930
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<br /> 14.5 Insbuceans antlAdtliBonal information
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<br /> 15. GENERATOR'6IOFFEROR'S CERTIFICATION:Iherebydeaare Nel Ne.nhnts of Nis.nsignmenl are hllyaM aaurelely described above by the propp shippirg name,ard areaassNed,packagatl,
<br /> marhetl and labeletllpla.metl,aMare In all respeaa in proper.ndl8on for UanapodacwNing toapDll.ble Inlemaemalantl natlorel
<br /> Exppler lcerlity Nal the.ntenlemNk.nslgnment.Mormw Ne terms mNe aaachetl EPAAcknn.Netlgmenl of Consent g�m '�ulatiore.If exTorlsM1ipmenlantll am the Primary
<br /> 1.my Nal the waste minimUation slalemmt ldenafred In 40 CFR 262.2T(a)(it am a lame quantity generelor)or(b)(tll am a small vuana
<br /> GeneralolsrOBeror's PrintedRyped Plane yga.reNr)is bus.
<br /> Day Year
<br /> 16.Intema1J.an Shipmams I t
<br /> Importio U.S. ❑Expodfmm U.S. Pod of en I tl
<br /> ? imnsporleralgnalure(fora,Nareonly): -Datele"pUS.:
<br /> w 17.T2nsporler Acknowledgm.tof Racelptof Materials
<br /> —annoNer i Pdnletl/Typed Name
<br /> Sig awre Ir Monty Day Year
<br /> AA'v; fly ,_A 44
<br /> y Transporter2 Prnted?yp tlName Sig awre Month Day Year
<br /> l18 oneorepter,
<br /> fee Dlaorepan.Y lnkalbn Spa. ❑OUandty ❑Type ❑Resitlue ❑PaNal Rejection ❑Full Relection I
<br /> Manilest Refere
<br /> 18b. Facility(or Generator) me Number
<br /> U.S.EPAID Number
<br /> LL FecMV Phone: t
<br /> W I&.SlAnalure 01Al1emele FBClllly(Or GenBIBIOr) Monih Day Yeaf
<br /> 1A.NUWoue Waste Report Management Method Codes(let,codes for hazardous waste treatment disposal,and recyding systems) 4
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<br /> I 10.Deelgnatod Fo,n,l Owner or O..Ior:Cerllr,.Vart of recelpt of heza doue materiels covered by the manifest except as noted in Item 18a
<br /> I"yped Num 61Anawre Month Day Year
<br /> -APix VOO-22(Rev.12-17)Previous editions are obsolete. •
<br /> Lydia Baker, SR. REHS Page 1 of 1
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