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5112 W HWY 12, Lodi Record ID PR0528438 <br /> 1/17/2020 Hazardous Waste <br /> Photo 1: According to Henry Rotor, Safety Director, metal fines are generated from welding activity. The fines are swept up and disposed of with the oily <br /> absorbent and is hauled on a uniform manifest under waste code 352. No waste code for the metal fines is noted on the manifests. Manifests incomplete. <br /> l 1 ,t l I. iO I I'l m:nl,, Farm AEPP'i.OMB No,2050-0039 <br /> Ylaeae plllller I M. <br /> Form de, rrntnr IU Nnm4pr /,Pugo 1 r l Emorganry Roaponaa Chane 4 Mani}est Tra[kmg Number <br /> rn V T <br /> UNIFORM HAZARDDU9 <br /> WASTE IRANIFES7 - <br /> hGenornlar'a Nomn and Mrlling Nddmas _ Generature Siteminaea 111 difrerenl Iran melling a"wel D r <br /> m r <br /> GenbraWfa Phone: <br /> U.S.EPA ID Number bTr ati.rl mpam Nems .F <br /> ss ORLD U0.F:Ns'IRisFlM1fit•I IFIL�s�:Ftvl^F.� C A D Q 2 8 2 7 7 0 3 B m <br /> nnnsponer,2 Gam Neme U.S.FPA lO Number V A <br /> nR�uw rtec=,v�,, <,rsr ra 11t:: G A R U C O 7 7 5 4 2�- ` <br /> I <br /> A.➢eel nal FBCIIEy Name Antl SjtsAddrass U.S.EPA ID Number G <br /> s4ar��erarrr� rd� <br /> ".UV irG W6.41WAY 11'rab <br /> ;i l_W�O3521146 <br /> a<= Faclll ePhone: <br /> 9a Bb.U 5,DOTDesr�elton(Including P ni Shipping Neme.Faeerd Claes,IG Numli I K.Containem 11.Total 12.Uni! 13_Waste cedes <br /> hIM and Packing Gmup(if enyll Na Type OuanEity WhNo1. <br /> K _ _ <br /> O <br /> 4 <br /> rr <br /> w <br /> z <br /> w <br /> - 1 <br /> 14.Special HandlSng Inslmceons and Rdditional lnfomratian <br /> _ 15. GENEAITORVOFFEROR'S CERTIFICATION:Ihere6y deUare that the ounienls of this mnslgnmenlam hilly ar,G a��raely desai6ad above 6ylhB proper 5hipping n2me,dcd die tldSsIfied,pa4kage6, <br /> marred and Iebel ahp-ri and are in s11 respects in proper cant.,for transportaccording to applicable in.—honai and national governmental re-0Ne4ons.If miaM shipment entl I am the Primary <br /> Eepori I ceairy That the wnlenis of iris—alignment conform to the terms of the attached EPAAckneerledgmeil of Consenl. <br /> Icertifythatfhe wastem1nlmtaatians1atememidentl8ed in 40 CFR262,27(aI(If I am alargequenha generator)orld)(III amasmall quantity genaratorlis true, <br /> Genemlore101fenrs Ponmdrrypad Name Gl,gnatwe M"U' Dag Year <br /> 18.Inlemair-al shipments <br /> ❑Impartta U.S. ❑Export from V.S. Pon of enlryfeKit: <br /> z Transpenv signiN hor exports only): Date leaving U.S.: <br /> - w 17.TmosponeeAdnoellsdgmem of Receipt of Materials <br /> Oe Transporter 1 PPnnteprr"d Hama ) / Signaiune hlnn"n Day Year <br /> Transporters nnledlTyped Name _ Signature Mocdl Dar Year <br /> De <br /> ~ 18.Disuepancy <br /> 18a.D'uscn:pansy Indication Spare -El Quantity ❑Typ e ElResidue ❑PaNa1 Relection ❑Full Re;ecbcn <br /> Mantles[Reference Number: <br /> 18b.AEemate Facility lar Generatoq U.S.EPA ID Number <br /> �r U <br /> w Facililys Phone <br /> y�j ilSC Signature afi Wtemale FacilVty(or eneratar) Munrh Day Year <br /> r- <br /> Z <br /> N19,}tazardous Waste Raaan Management Method Codas(,e.,codes for hazardous waste tmatment,dlspasal,and meyding systems) <br /> O 1' <br /> fl: 2- <br /> f (; <br /> 20.Oesignatetl Facility <br /> Owner or Operali Certification of receipt of ha rardous materials coveretl by the manifest except a$ntledin uem IBa <br /> 1 Prinlad(TYpetl Neme Signature Month D" year <br /> EPA"'m 8700-22(Reu 3-r}51 Previous edllions are ohsole;e. - p SIGNATED FACILITY TO GENERATOR <br /> John Alaniz, REHS Page 1 of 3 <br />