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120 East Wetmore Street PR0537553 <br />July 24, 2018 <br />PHOTO 2: Uniform hazardous waste manifest number 006101114SKS was found without a destination facility signature. <br />Form Approved. OMB No. 2050-0035 <br />nelite (12-pitch)typetsrl"" Phone 6. Manlbat Trucking -,b,r SKS <br />hoe. ,,on designed for can o - 2 page 1 rf 3. Emargency Response 'f <br />P!,printor nor, 1 GeneralmlDMumbN �t;? <br />U WASTE MAN FESOUS Ganeamrs Site AdEress pt off_,,an mailing address) <br />-, a,,..rs came and Malfirq Ads„�- — <br />U.S. EPA ID Number <br />'- U.S. EPA ID Number <br />U 5. EPA ID Number <br />S.Do ynalaa Fav'n Nane aria Sile Ad]rz;s <br />ixi-tys Pso. Conterars 11. Total 12 Unit 13. Waste Dodes <br />E ng Proper SM1ipping Name. Hazard Class.IDNumbar, No Type puantiy WI Not. <br />dt <br />O <br />K -- <br />3 <br />4 <br />td. Special Handling Inshucdons antl AdtlNpnal Infortnakon <br />15_ GENERATOR 51OFFERORSCERTIFICATION Ih byd G N Ithe t t of th' iq t Nllyand lyd cnc above by the proper sli pp tg name era are class Fetl. pack aged <br />. <br />areaanb labeledplacarded. aria are nail inspectsn proper randtonfor nolsport acmrdso to app)wble ntematoralad nato d9 emmertal regulators. If export sM1pine, and lam the Pr maty <br />EapoMr, l cediy Nal the,,tents of Nis mnsiq—d conform to the terms of the adarhad EPAAcknowletlgment of Consent. <br />ce” did Ne waste minlmlzation st,t,—dr,ufiW in 40 CFR 26221(.) if l am a large gr..ty gar-ton or (b) (d l an, a small gosntiry generemr) is true_ <br />G—hzlsl0fiero P,11.dlryped Name Slgrature Month Day Vear <br />ifi.IrMmatro IS'mehts ❑Impodto U. S. ❑Expod from U S. Port <br />T-".' )for expods only)- Date leaving U S <br />W 11. TransprnerAcknoMedgmentol ReceryN of Materials <br />Traraore• 1 Printed7yped Name Skgrrature Month Day Year <br />0 <br />.,. Q Transposer 2 PdntetlRyped Name Signature Month Day Year <br />I} 18.D—pan,, <br />18a. D-apancy lnd ubc, Space ❑ DuanGty ❑Type ❑Residue ❑ partial Rejection ❑Fun R_e"n] <br />sL Facd,Vs Phone: <br />18c.S191*1e ofAltemate Falityfor Generator) A4onln Oav <br />G +e <br />Z <br />. N 19. Hazardous Waste Report Management Method Codes d e., cedes for hazardous waste Ueatment, disposal, and recycling systems) <br />�0. Designated Facility Owceror 0peralor Cerdficalion of receipt of hazardous materials covered by the manifest except es noted in Item 18a <br />P1lnled/Typed Name Signature Month Dey Year <br />a <br />EPA Form 870022 (Rev 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />Lydia Baker, EHS Page 2 of 2 <br />