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3900 Holly Drive PR0535446 <br /> April 2, 2019 <br /> PHOTO 1: Manifest 00176820DAT (9/12/2017)found without a sigeuned off copy from the designated facility. <br /> ".:I on;:!,12X1 1 -9 rpp— .vmo rvo.2�,O- .+y <br /> 2.Page 1 of 1 3.Emergency Response Phone d.Manifest TfacMing Number <br /> 00'_ DAT <br /> Generamrs Site Address(if d9e2n1 than—09 address) <br /> Ids t.f <br /> ILA 4%1 <br /> US EPA IO N—ce- <br /> U c E- <br /> U.S.EPA ID Number <br /> 10 Conte rd� +_Total 12_Unit <br /> Q—bty WLvd. 13.Waste Caces <br /> I <br /> GENERATOR'S OFFEROR'S CERTIFICATION:IhWgydeciarethatdrecantentsoftlnsmnsgr r trekMyanoacara"desubedabovebytMpmWshppignarne aro are dassiretl,pa,ageb. <br /> _. rded,i M are Nall respects m proper rendition for transport aaradrV to apoiHable intem2tioral and natiartal vermnentg <br /> atra <br /> i's Corterr6 dtivs consignment conform to the terms of the ded EPAAck mptgtios'Naxport sn'M`ent and I am de P.rcnary <br /> nowlMgrnanl of Consent. <br /> - _ _ - d minimvatipn statement itlerltifed in 40 CFR 262.271a)(d I am a large quantity gener br)or Ib)(if I am a smaN quanOty gerrIXebr)is tue. <br /> ramfsDlMoes PmledTyped Name Sigrahae Momh Da. <br /> ---_=doral Shprreres ❑Impodto U.S. <br /> ❑EKpatfrom U.S. PM of e <br /> .,.�...e��yl, Dare.,, <br /> __-ent of Recegt of Materials <br /> -- Name Signature MmT Day "ev <br /> porter 2 PmtedrTyyed Name Signature MmU Day Year <br /> _.ace ❑Quantity Tyle ❑Residue neA... �F�Y Reyes^om <br /> Manifest Refeier os Nunber: <br /> U.S E. '1.....:. <br /> acerdous Waste Relood Mana9errent Method Codes lie.,codes for h—dous waste beaMent.disposal,aod recyding syslemsl <br /> 2. 3 <br /> es5rated Faaary 0—or Operator.CeN6rabon of receipt of—ardms materials covered by the manifest except as Med N hem+Sa <br /> rdfTYp-lWre Slpnamre <br /> n%-221Rev.3A51 Previous ti tions are obsolete. GENERATOR'S INITIAL COPY <br /> } <br /> Lydia Baker, REHS Page 1 of 4 <br />