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7679 Longe Street PR0537564 <br /> December 28, 2018 <br /> PHOTO 21: Manifest 012177654JJK observed with an incorrect ID number. <br /> Form Approved.OMD Ito.2050-0039 <br /> Pleeseptlnt ar lypa.(Fnrnl designed to,use on elile(12-pitch)typewnle,) Xing Number <br /> P a, UNIFORM HAZARDOUS I.GenerelalU Number 2.Peaetol 3.Emeganq Rasponsn Pnone eM�ua`al ire JJK <br /> Y q WASTE MN NIFEST <br /> �U anemlola mm�non lRalnn Addmss Genaretpya sgeAdtlrese lRd�nernm Nan madug atltlreaa) <br /> GenemloiS vnonn: U 9.EPA IO Nu <br /> ansppderl Company Nano <br /> EPAID rvamm, <br /> 1.Tmnalmne"zcompare Name <br /> U.S.EPA ID Num4r <br /> si tlFadllry Nameand9XRgRnrsss <br /> ( <br /> FRellny'R Ph— m.Conlenem 11.ipm 12 UnR <br /> 9b U9.Doi Dxsmptbn lln4lpdelg Proper alnpping Neme.HererR Class,ID Nnmber assn Godes <br /> H4 roup laamll type ouanury Nal. <br /> 2. <br /> u <br /> 3. <br /> 4 1— <br /> 14.Spade)HantllNg lnsWNpns entl Atlditional lnfprmatlpn <br /> 15.GER—R'SIOFFEROR'SCERTIFICA310N:Ihecby—ne Nat Neaneltnt Nis mnsignmenlarefullyand aavmlely tles[dbetl above bythepropar sM1ipping name.aN aredassNed.packaged, <br /> maMetl aM WbeledlplawMed.and are in all respects in pmperwndition <br /> 1. —1 no to 0llmble lntema9onaland national govemmenlal regulations.dexpoA shipment antllam tlN Primary <br /> Fxpwler.I re."Nat Ne—lanes of Nle—ignmenl-R.to Ne terms of ft,-k EPAkk,W dq.ind Cmsent. <br /> 00"NatNe waste minimeation srolemntitlentiGed in 40 CFR26221(al(Mlamelerye quantity gene2lpr�or(b((dlamasmall quan4ry gene2lor)is We. <br /> GenerarolslOSerels Pdnletl?Ypa`O Name SgnaWre' Monty Oay Year <br /> tb.lnlemeponal SM1ipmants ❑Import to ll�S. c <br /> ❑ERpaR from U.S. Pwtof enoyl exit: <br /> �iranspMersgnalure(rorexpwN only): Date leavingU S.: <br /> w 17,imrspwlerPrMowletlgmeM of Receipt of Maleeals <br /> 1—00 PRMedRypetl Name Signature Month Day Year <br /> i Transpotler2Prinletl(iypetl Name Signature Monty Day Vear <br /> } 1a.015crepanry <br /> 1Sa.Dl—Fna ytrXlicabon Space ❑Doarety ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> me.Nlemata Faalily(or Gan q Man8esl ReMellce Number <br /> U.S.EPA ID Number <br /> LL <br /> Fed 41)"a Phone: <br /> w I&.Sgnalere efAllenns,FadlRy(or Generabr) <br /> i Monty Day Year <br /> N19.Hao—Waste Rapotl Management MadOd Codes(.'Oodseforhama s heaMenl,tlispoSal,aM recytlirg systems <br /> ) <br /> 3. 4. <br /> .Devgnatetl Faos Dwnaror Operate,',CetifiaOan ofreceiptolhazallous maledalscoveretl 1 by Ne manliest aRcept as need in Ilam l8a Pleil¢yFWad Name GignaWre <br /> Mamh Day Year <br /> EPA Fdlm 8700.22(Rev.3-05)P2vYous editions am obsolete. <br /> GENERATOR'S INITIAL COPY <br /> Ero <br /> 6? 9 EPR "A� <br /> 61' /6 <br /> haps://hws.dtsc.ca.g <br /> Lydia Baker, REHS Page 21 of 21 <br />