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3927 East Clark Drive PR0514138 <br /> October 10, 2019 Program: HW <br /> PHOTO 201: Oily absorbent and debris disposed of as non-hazardous waste. <br /> ARWUS I I� I „b1 ^r101Y..tYt <br /> ` � WABTB NANIFFBi 1177 1 t. �t �Ma'l <br /> x <br /> nl ppktA ss-+.e-er t-v, ea 19709 ver <br /> -796'3 <br /> �a..rem ggel. <br /> J1720 X- <br /> L" Wriialo" <br /> 1�. An OS799 .. <br /> Fayu,rn„w f10-316`9010_._.. __ - -- lo.commren +r.Tow ,Unh 11A{ <br /> n Wa.0�rgy,uN Name ane lbsrdM�on No. Type dlerNly WI.No. <br /> �ol�wt YA <br /> ._, .i ,roi'lfri»tiiiw ttldJ� 3 a 0„� <br /> 13 Speoal HeWIrg lremx1kne and Addltbnel lnbrmaaon - ---i <br /> ---- <br /> 1) <br /> Y��!!Y —1lOLL1R <br /> 2- � <br /> .1 ice!�A�e sus cln�ia4i **$ of 1 nmerae c> <br /> 424—MM i0ast iii 00=974736; M*531031 / 10"GUN6 / MW (000 <br /> t (/n <br /> 14.0ENERATOR'SUFFERORS CERTIFICATION:I hereby declare that the wntent mis Cpnelgnmenl ere lull,and accurately deecdbed above b aro proper shipping - - - -' <br /> meMed eM Wbeledblecerded,erid ere in all respecre In proper WnMlbn for transport accoNirg to applicable Inlematlonal and national gov mantel r pulaetlonsname,and are classMetl,pecNaged, <br /> GNrererolagllem'e PMrled?yped Name Signature Monts Day ;Bar <br /> I5.ImertOlbnel$Mpmenre UVJ I <br /> EJ.Pod to U.S. ❑Expon from U.S. Pod olentry/exit: <br /> Tran ,S sabre ex for soul: Date leavin U.S.: <br /> ¢ 16.Trensporter AcNnowledpmentaf Receipt of Mali <br /> TOrreponer I Pnnted?yped <br /> g Signature Monts cD7aS7y Year <br /> Transports 1 PrinredrTyped Name ndkv Signature ' <br /> Month Day Y- <br /> 17,Dmc"parmy <br /> IT f7e.Dleaapancy IrMication Space <br /> ❑Ouantiry ❑T . ❑Residue ❑Partial Rejection ❑Fug Relectbn <br /> f-Alfamere Facility(or Generator) Manifest Reference Number: <br /> U.S.EPA ID Number <br /> Facility's Phone: <br /> I7c.Sigrralwe olAlfemale Facility(or Generator) —--'- <br /> Month Day Year <br /> )esignated Facility Owner or Operator:Cedlfication of receipt ofmaterials covered by the man--exce 1 as noted in Item 17a <br /> Yin Name �— _—_— <br /> Sign ure fdo y Year <br /> lI FI, <br /> 0 5 11977(Rev.91 9) <br /> ESIGNATED FACILITY TO GEN ATOF <br /> Lydia Baker, REHS Page 39 of 39 <br />