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2041 Navy Dr, Stockton Record ID PR0521437 <br /> 11/26/2018 Hazardous Waste <br /> Photo 25: Manifest not signed by the TSDF. <br /> Please pnm or rypa.{Fom1 designb6 for Itse on elite{I2-pltch)I l <br /> UNIFORM HAZARUGUS 1'Ga'e21orlQNumber 2.Pegataf 3.Emergeney Reapunae Phpm ,,Maaaesl Trud gNumbercv OMSNa,205G-gg39 <br /> WASTE MANIFEST <br /> S �� <br /> Genemlors Nema end MeitingAddless <br /> Generemis SAe Odtlre,5ldtllb--I than ma ling address; <br /> V <br /> ,. Genemtdfs[anone', <br /> .. 6.Transpoder 1 Company Name - G.S.EPAIG Number <br /> - i.Transponar2Gompany NemB <br /> IIS.EPA IM Namber <br /> I <br /> B pesignaled Facility Name antl 5'leAddmss <br /> U.9.EPAI�Number <br /> Pacil'i Pnenn: <br /> u,5.DDT Q lr,dplion finraueing Proper Shipping Name,Hazard Clear,ID Number, Ig.Ganhlnem <br /> HM and Packing GTYp if,,ji t1.Tpgl 12_Vnir 13.Res,Code, <br /> i. 1. No. Type asil'y 'M NI <br /> 2 <br /> Ute' <br /> i 3 <br /> LL 4. i tl <br /> A- W.Special HandlinBlut-tionaarrd Addi110nal Information r <br /> 15. GENERATOR'SIGFFERGR'SCERTIFICA71GN:I hereby decla2 that the wtenh of NR eansIgnmemare fully and—di deeraibed ill byfw prgII shipping nema,am are d-ied,parYagM, <br /> marked and labeledlplecarded,and are In ell—pet in proper eonditon far tranSpOha=m %inapplicable intemalional and net 1ggoemmantalmgulation5,If eapcN shipmon;and tan Ne Pdmary <br /> Eepmter,rcdlty that Ihg coolants Mlhis wnsiAnment conformmthe mans of th s[ ed EPA Aoraluwledpmenl al Cas�M. <br /> !oeldfy 7x91the 1v9atE mini—lion elelementsdentfiedin9001FR 252.27(a)(if l am alargequantitygenemlm)or di—a small quantity ggneralar)is WB. _tea <br /> Genarawrs;Otierars Prlmealiyped Name Sig... c �'F Alontn aay rear - <br /> s 6.Int—Vera15hipmenla <br /> ❑lmpmtbU.S, ❑EkpOd lrom U.S. dolt olentryleNl', <br /> Transpmtarsignature(for aeporb only). Ilam leering N.S.' <br /> W 17.TmrrspoderAckirmledgment of19fMate riaIs <br /> Trenspniterl Prinladfrypad N— Sipnamm Menm Dar 'reel <br /> 4 ` <br /> r•r. 2 Transportu PNniedflyped Name Signal- Monty 00 Year <br /> x <br /> r <br /> If,.D <br /> 1lcrepagsy <br /> If,. iserepanq lrttl!caSon Space �Quantify ❑Type ©ftesid.ee LI Pell Rejection OFUII Raotl19P <br /> Manrfesf Reld—Won., <br /> LLfi.EPAIQ Numder <br /> Fes-, 18h A![enla7e Faellity(ar Ganel'alnr} <br /> U <br /> Far+tiffs Phane', M1+mdh oar rear <br /> tBc.SiAneture ofAltamaM Feoility(or 3—dr oT} <br /> 4 <br /> T <br /> ' i Ig.Hazardous Warta Rayed Managelaenl Method Lodes(i.e.,codes for haeartleus waste lraatinent,dispose!,ane recyd+ng systema d <br /> I 2p.GesiAna!ed FaciliEy Owner or Qperafur;Csrtldca7inn of mmipl glhaaErtlouS maleA9is— <br /> Print <br /> s ce"+ehyNis msnNest eaoapl9s noted in lrem l8a ger <br /> f SipnaWre <br /> jlll Printadliyped Name <br /> GENERATOR'S INITIAL COPY <br /> EPAFGrm$700-22{Rev 3-05)Previous EOitione 8fe phaplete. <br /> John Alaniz, REHS Page 25 of 29 <br />