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800 W. Mossdale Rd. Record ID# PR0514467 <br /> 8/5/2020 Program: HW <br /> Photo 14: The following uniform hazardous waste manifest (0 1 7467872JJK) observed with no signed copy from designated facility. <br /> T lease F AP mvsG,OMB No.n50-0139 <br /> loinl ar (Fpm deo-ned rq use nn pure 12yedl 1 ;� <br /> i UNIFORM HAZARDOUS 1Ganarw^IU Nu,e�Oa. 1Pge1tl ]EnwgecyRnw.na A�w+ 4.Msnenl T•sc><nq N+rsear <br /> ' WASTE MANIFEST JJK <br /> - <br /> .Y 5G«arareM1 Name meuWgAtlfnx C Io+v s�4 wmsss lit bnMmt nae m.�+e.mmsl 1`51 <br /> ININs1ryR:.a.Ru IlYr +N <br /> ov�er.rare Fliana. -.]^ �G �.d„V - • <br /> a.rr,n.nwlar 1 ca„parry Name <br /> WOULV UN"r e1lniRMtiYiAl itlMl;tS - 1 <br /> it 7 Tlanpyr,er i Co.,,Narna US Evn to N�mna� <br /> Wt1NLOW1UL Nt •r;OyfRy V'S rt_M IN(; <br /> 9.Oeepru"Fwat,Nema sip p Add . Us EPA 1p Nun+ber ' <br /> TUW]ES LLC - <br /> "+Wtlalti9fi <br /> rtlMA A2 A5s6S A 7 R rl TI p 1 <br /> Faali Phone: <br /> 9a. ab.0-S.OOT nescnppnn(Im7ady Pr,,w Shlppeg Nam.Harsh Ciao,10 NurnbOr. 10.Conlalrien 11.7tlal 12.UM 13 Waste CadeS <br /> s F r RM and Ppdilrg Glow(11 enYit No Type Crun9h' WINeI. -� `• <br /> 1 <br /> . 1 f4UfJa N_RA IIAIAR0QU*i WA31 Y. =YJL;U(QALY SOi.lU PAVLF#FiLl H4 1�U tt1a - <br /> T 2 <br /> :,Av, <br /> 3 1 <br /> • <br /> _ a 1 <br /> • 1 <br /> t 1a SFecial Hantlling lrtsWclion5 and Atltlitional ln}omldlipR l <br /> 0 1-900 424-92ILKI WOES TERMitYAt.Ct NkS L.'`, ^FI!l1PYLt M yisl 3lalti"1:lNKS � - <br /> �OPPIATh i'Elt.;(JNAL PI"01H I'lt f.rel u•rwI-' �1_'-:yf SGS <br /> w g s <br /> 15 GENERATOR'SIOFFEROR'S CENTIFICATION'.Thereby dedare tliat the mnrenis of this consignment are Mlly andaccurand descndedabove l�l Pmalarfs It exPoame,andatedabsitad,packaged, <br /> markad and laAadlpla—ded,and are in all resp In proper ooMdon for transpnd according to applicable VNemational and national govemmenlal regulaiions,it export shVpment and I am Ne P11mary <br /> Expwler,l wrtify lhel Ne oonlems of this tanslgnment mnfarm to the terms of the attached EPAA knowletlgmem of Car�senL 1 p <br /> I oertiy that the waste minimization statement identified in 40 CFR Y62.27I9)p11 ann.large quantity generator)or @1 tdl am a sM0�1A <br /> I quantity generalorl is a1re. ggpaaa��p <br /> Gerre1&00Nerors Primo&Typed Name ure,'_a <br /> r <br /> i 1 <br /> 16,IRlemagonai Shipments ❑ImpnNm US. ❑Expod from LIS, Pon of enlrylexit: - <br /> . z Dale leaving U.S,: �. <br /> Transporter signalure(for exports only): <br /> f' 7 17-TransporterAck.Ma dgmentol Receipt of Matenala y.!onth Day Year. <br /> 71f 7) Sgnaw[e <br /> Transporter 1 Pnnledrrypetl Names � i /ez" .t jr r ■ <br /> OILg [� dente l7sy Year <br /> U) Transporter 2 PrinlerlrTyped Name Si nature <br /> a <br /> F- <br /> Discrepancy <br /> tea.Uiscrepanl:+/IndipaEipn Space 0 Quaduly ❑Type ❑Residue ❑Pamal Rejemlon ❑Fu4 Relechan gift <br /> ManHBSi Relelence Number <br /> U.S.EPAIR Number <br /> 18b-Allemale Faciiily(Of Gen8ral0l <br /> w— <br /> J <br /> i Facility's Phone: Month Day Yow <br /> w 18c.Signature cf Allemale Facility(or Generator) <br /> Www Q <br /> i (D 79.Hazardous Waste Repod Management Method Cortes(i.e„codes lar hazardous wade Vestment.disposal,and recycling systems) <br /> 0 1 2, 3. 4, <br /> . 20.Designated Facility Owner or Operator:Cedilinallon of receipt of hazardous fnalenals covered by the mardI except as noted In item 18a Month Day Yee, <br /> PdntedlTyped Name Stgnatura <br /> . EPA Form 8700-22(Rev.3-05)Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> J <br /> JASON GAITAN, EHS Page 14 of 21 <br />