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10812 S Harlan Rd, French Camp Record ID PR0514315 <br /> 5/11/2020 Hazardous Waste <br /> Photo 5: The underground separator, oil-skimmer container, and holding tank are periodically cleaned out with the waste being hauled from the site as <br /> hazardous waste. The uniform manifest is from a cleanup. <br /> Please print or type. <br /> r UNIFORM HAZARp0U5 1,Garrerefor lO Ni Form Approved OMB No.20%4)D39 <br /> j 2.Page I a! 3.Emergency Response Phone 4.NI fleaiT chin NurrAer <br /> EMANIFEST CAROL-• 1 (ROO,424q,104 6271°57'947 JJK <br /> 5.Ge a aldr,Named' <br /> Mapin llp�di <br /> pk LTA TRUCK CE�gTFla aeneramra silo Address 0 dill 11 man mailing atldressl <br /> 1018: L1A1tLAN 10182 5 HAFPLAP( R No 85N 3s <br /> FP,ENL'H cAMP CA 95231 FRENCH CAMP CA <br /> Generarnra Phone doe ee&1400 JJ K <br /> 8.7minaporler I Company Neme <br /> U.S.EPA IQ Number <br /> Ill Olt ENVIRONMENTAL SERVICES C A 0 0 2 8 2 7 7 0 9 8 •+.' <br /> 7.Tmnspoller 2 Company Name <br /> US EPA 10 Number <br /> 6 Designated Padlity Name antl Slla P,ddracs U.S.EPA IC Nbmber <br /> WERSFIELI7TRANSFER INC <br /> 1620 E BRUNDAGE UUVE <br /> 8MERSI'll GA 93':>r CAI 82698 <br /> Eesti sEhone: (6611;17 i-0308 <br /> ga. Sb.U.S.DOT Oeaa10-m Ind izlmg Roper Mini Nemo,Harald Cld,a,lC Htlmlj;., la.Containers 11 7dWl 12.Unit 13.Wasle Cali <br /> HM antl Pachtrg Group Ipdnyl} Np Type Ouantily WINoL <br /> ¢ 1. NON KRA HAZARDOUS WASTE LIQUID Kill_ WAT I T <br /> o l�fu� <br /> a <br /> sr <br /> w s <br /> z <br /> w <br /> f'J <br /> 3. <br /> 1 <br /> 14 soeml Handling lnsftmi ans endAddidonal lnfbmlaeon I <br /> EMERGENCY CONTACT CHEWI ll 1-800424434 WOES TERMINAL WON NAERGR 981 171"PROli M 983 051414f <br /> 19-BT)•EMEI CONTACT CHEMI 1-800.424-8300`A001TI(NIAL EPA CODES 981..NONf a APPROPRIATE <br /> PERSONAL PROTECTIVE EQUIPMENT 4 I f'2 14 <br /> 15. GFNERATOR'S)OFfERdR•5 CERTIFICATION:Ihereb dealam prat the—ten"Wsw �- <br /> y n5lgnrrlbn{am Ia11y dA1 amraldY da3f,Abatl ono by trl6 proper Shipping nelna,old are elasslfied pa kaged, 1 <br /> marked arW labeledlplacard{,and are in all respetts in proper Candlfion for transport aggprdirq Iq applicable intemaLaPl18M national gpvemmenlal fegul5ligla.ilespOrl Shipment and I em the Primary CF <br /> Exporter,IcerH, <br /> ti conlents of this cansignment donloml Mthe tams oftheattaaired EPAA&moaee i—I q!Coit nt ,$ <br /> I cerlif lhel the wdata minimiZalion 5jalem of d-ntlwd In 40 CFR 262.27la)flf l amara a M1ti a lof of fill oma email flanll Z <br /> rg qua tygenre 1 q Ngeneraleq is nue. <br /> C>el_w1m-tgr9NAemfs PppOedfTypetl Name Sgnamre 2.. iDay Year <br /> --J <br /> 16.€ntemaMnal Shipments <br /> z ❑ImP.t'U S, ❑Eepoll from U.S. Pon of em Aol d <br /> Transposer signature(!cr eepgns only): Dai,leaning U.S: <br /> w 17.Transpwmr AShnrnNargmenl of Recelp[M Maledal9 Yea <br /> Transpolar I PlintadRYped Name ma <br /> r1- Sign / MPnN Day Vear <br /> z lranapol¢r 2 Pm,wdrlyp dl Name I , <br /> —- } Q 3 <br /> a6, 6kgnadue Month Day Year <br /> 4 <br /> } IB.Disnrepdncy `ad' 4 <br /> }I11 113-.pscr¢pa%y Indicalivn S,_ R' <br /> ❑0gantily ❑Type ❑Resitive ❑Partial Rejection ❑Poli Rajemgn yeol N <br /> h 'ap All rMardf-rh �mate r g <br /> ry <br /> V U.S.EPA ID Number <br /> � LL FaVli I w <br /> lys Phone. &:i;n � <br /> w �&,_SiArNlure of <br /> Allemale Facility for';BnMalor) <br /> Q <br /> Month Day Yuar <br /> N 19.Hasp-ue Wdsle R¢p-ll Mdnagem¢lrt Meldpd titles{iR,wd.,for hawrdgUs was4e tredlm-nt,disAOShc,antl re C <br /> �i z ryding systems) <br /> 9 <br /> 3 4 <br /> ep.Dl Fa ll'gy pa,nera Y r <br /> Pvaaaffred Nam9 QYerabr:Cenificari0n al receipt of halardW-materiels coye{ed by lNa mdnihs[eaaepl as ne(etl in tram 1E9 <br /> EpaWre h1o�rh Day Year <br /> EPA Fram87011221Rev.y2-17)plevioms etlippns are obsolete. <br /> GENERATOR'SINiTIALCOPY <br /> John Alaniz, REHS Page 5 of 11 <br />