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4555 McKinley Ave, Stockton Record ID PR0538495 <br /> 8/12/2019 Hazardous Waste <br /> Photo 2: Manifest number 009912545FLE 11/28/2016 was found without a signed off co from the destination facility. <br /> .a„s.11— ArhrsaaF 8nw Ka <br /> N.OW22tl 7 020,0112820 <br /> cAo co.3sss 02G1609292O- <br /> 2rY.>a.poas - CAOtl[aQp9g55 OZ0160,92920i <br /> raae I er Form npyrovoa.�i9,tB No. C <br /> ��9n^W NeMs�..Ynnin a,Mefn�1x11TTff,,�]]e Y!Z545 FIL G . <br /> ran61 erenl an maAl� I - ' <br /> a Can Nemec i-i9Fp#hh[1:-4,1'S.'1VQ _ <br /> n y <br /> V.S.EPA ID N-nnber '•, <br /> dl�b me en C1lplpliUTlltAf1r <br /> -90. [ea <br /> l}.3 E AID Numh¢r <br /> a Pn9ne: W4�7tD7 mter V.S.EPA ID NJEm9rpenry R¢sponse Phone FDrf <br /> -- Ragti <br /> - Pe. Ob.U.S.D07 raiork Site <br /> - nottnption(inqutlin Pro er Adaresa(irdererenl Nan more addresa <br /> rA antl Pack Group(iranV31 p P 9hl gNama-Ha dm Class,ID Num <br /> pilin <br /> I'4r bar. <br /> n FtARa �y��� ��r ta.ennealoa-s N,T9[al I2.u-m _ <br /> y Wok`1C Nn' Type Odontity 'NI l3.WBal¢Cndes <br /> � Sair!fEIY� <br /> w 2. +F+i.4 P US.EPA 1O <br /> (, _ Number <br /> U.S.EPA ID Number <br /> 3 <br /> U.S,EPA rCNvmber <br /> - 4 <br /> 7.Congq� <br /> - T rr.in!7'Dfal <br /> 14.Special Nandling fnstrUclions',IAddlllomal 1,onnatlon ype Qu12 Uryr <br /> _ �] <br /> 1,1 h!.f56<'Tay F la -fyy+0eclrhimr36mr h �-.3 <br /> _ r[ <br /> 'r <br /> 15- GEked and IasyOFFEROR'g CERTIFICATION IherI dedore that the mnRrds oTlhis conal nmeM arefully and accurately tlesrrhed above by the pmper shipping name,and are uaasiaed,packaged, <br /> marked and faIfy that 1._d,and arein ell respects in proper candeion for transport according to applicable imemaliona7 and nagonal <br /> Ekpprter,I tartly that fire contems oftnis consignment conform to the Earms orthe aa9phetl EPAArkn9µladgmenl of Consent. g9vemmenlal regulations.N expert shipment end t am the Primary <br /> J cediy then ins wastemin im Namstatemem idenlihed ingg CFR 262.271a){if I am a large quantity genemWr)or{bt lir I ama small quantity ganeratogis Un <br /> III rola nnletlffyped Name - <br /> t igna re en ay ea <br /> -a 16.Intamafionai Shipments,� t. I <br /> ~ ❑Import tD u.s. <br /> ❑ <br /> Trans odersi nature foraKportsonl ExpoRrrom U.S. Pott of enlrylazif. _ <br /> y� 17 Tanspo erA knowedgmeofalReceiptofMaedas Cateieavin u5: <br /> Transporter 1 Pnnledlfyped Neme., <br /> gnature oath ay <br /> ` 13- t ,...�. } } ear <br /> d Transpoder2Pnnted Typed Name 5ignaNre - _ <br /> � I:'.antn oar ear <br /> No< � <br /> be18,Discrepancy � pmpers. <br /> 121, r lea.Discrepancy Indication Space m9LI0ggep n a+a'+'arp <br /> fll ❑Quantih ❑Type ❑Residue ❑Partial Raprjien ❑Full Rejction hb <br /> emlOr}is e, ✓'menta ed F <br /> P.m am rheA <br /> lel c <br /> mus Manifeel Reference Number. <br /> wa c 181o.Altemate Facility(or Generator) U3 FPA 10 Number Mond <br /> � J <br /> U <br /> u Facilit's Phone: <br /> w 16c.Signature ofAltemate Facility{or Generelor) —` <br /> F- Month Day Year <br /> a <br /> _ Z <br /> SHO I 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.disposal,and recycling systems) .. 'Month <br /> 0 1, 2. 3. A, Y <br /> -4 MDntn <br /> PER �. <br /> 20,Designated FacilBy Owner or Operator,Cedlfinagon of receipt of hazardous matenats covered toy the manifest except as noted in Item 183 Y <br /> Printed/Typed Name Signature Month Day Year n <br /> Perrrj EPA Form 8700-22(Rev.3.05)Previous edl@Dw are obsolete, GENERATOR'S INITIAL COPY , �FWI Rei <br /> John Alaniz, REHS Page 2 of 10 <br />