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800 W. Mossdale Rd. Record ID# PR0514467 <br /> 8/5/2020 Program: HW <br /> Photo 17: The following uniform hazardous waste manifest (018170162JJK) observed with no signed copy from designated facility. <br /> *R�, oo e„a ao Sae <br /> eftg r zper,a al rr�.w,. <br /> Y-Hl Matar>=r <br /> r sc eNc�wv�nP <br /> p P 0 Bcu J 4--,w <br /> �(�/'F unrwiw ^T - <br /> CA <]53uJ W MCFSTJN.E AU <br /> r 3J7-b(l16 IATNFIOPCA <br /> � n — — <br /> a aNOp10 O/L E1eyrls�yeMFNTRI.'aFITYICE:Z u[�P02 R21TOJ6 <br /> W0 tLbwIDF.RFCtly nrw r rrM INC r;A <br /> <N RFU 0011#5422 <br /> �^ a lb Wt}EME'NT a.EAIo <br /> Zl 6'500 US Nr HWAY 95 <br /> e.T YUMA h 461d', A 2 F 0 0 0 5 2 1 l A S <br /> Pnne <br /> ft &a.l'.S.OOToe.o,Ybn(i's1dM➢P-9„sve�a Ns+e.Naswe 4an.XarMaw. w. 15.T[M tt.lMsl 53.Waxe Codas • <br /> g tfM w,d Pac4iwC Win wryl) ppr��WA 1Y Own+% WtNM. <br /> ? tN9N RC S <br /> RA HAZARDOt1 i W&9TE SOLS131 PKFFR"LTCB,') _l 3 <br /> Xrpl P <br /> ,$ U M <br /> t t <br /> Ir r� <br /> 14-Spacial karMling InsWctions anti Atldiaonal InbrtnaHon <br /> J rR E114El7G£NCY CONTACT'CHEMIREC 1-80"249900 WOES TERMINAL CEREU',CS NALW:ff 9a1 173�PROB Y flB] <br /> . 1 162623BR0095 PAPER F11 TFRS k "APPROPRIATE PPE EQUIPMENT !f - j��� j X <br /> t5 GENERA70RBlOFFER0,4'SCt-RTIFICATION:lharebytladare Plat lha moments efthls wrts6gnma,n are fully aralaw,r,tely dawbed above by tree proper snipping:ne,a�are rsassRtetl.pacha9M. <br /> Is marked and Iabeled/plarabed,and are in all respects in proper condltien forlmnsport exatling to applicable lntematiortal and national govemmantol regulAons-li export shipment and l s,a Ittie 9nmatY <br /> ` Exporter,I cartry a tthe.,telae or this—Ag nmentmntorm la the temcspl ala attached EPAApklwwledgmentd Consent. <br /> T I oanify Nat the wast&mininrimWn statement IdentPried In 40 CFR 262.27(ay(II l am a large quantity gem,")pr(b)(a I am a small qu"generator}ktrue, loon. Osy Yee , <br /> r Printed? Name Signature. _ _ <br /> emracsrOrfero s -•7 <br /> r Gen — YP&d - <br /> E7 1 <br /> • 16-Inremallonal5hipmenl5 Impart b u.B. ❑E..Port from U8 Port d entryiesit <br /> Transporter svmnire(for axPorta enly), Gale leaving U.S., <br /> C Monl15 Cay Yea, <br /> � 17.TmnsponerAckrwrvled9ment oFRecctipt of Materials <br /> . [ Slgnawre <br /> � TransparEer 1 P)inledrTyped Nemo_- / <br /> r •.� ' f 1 f Monet OaY Yea, <br /> (( ZZ Tr3nspo6er2 PdntedrTyPed Name Slgnalula <br /> • f <br /> By sl 13t <br /> j r <br /> 78.Discrepancy <br /> . ID 18a.Discrepancy Indication SPace quantity Type ❑Residue ❑Penial Rejeglwn ❑PuA Re}acUon <br /> * or rn <br /> l t� Manifest Reference%umber: <br /> row U.S.EPAID%umbar <br /> 18b,Aitamate Facility(or Generator) i <br /> colt[ U <br /> R - thin LL 1`864"Phone, Month Day `leas <br /> 11 n 187SlgnatureofAdternateFaciNly(orGenerater) <br /> • 1 z <br /> 19,Hazardous Waste Report Managamanl Method Cedes(Ire-,codes for hazardous waste treatment,dVsposal,and recycling syslems) 4 <br /> uJ 1 2 3. <br /> Thh d <br /> I,rn� <br /> 20.Designated Facility Owner or Operator,CWGation of receipt of hazardous male{Vols covered by the manifest excopt as nded in Item lea ?honCh ay +�1 <br /> Pnntedlryped Name Signature S <br /> . [.I <br /> GENERAI'OF1'S COPY <br /> FPA Form 8700-22(Rev.3-05) Previous edilions are obsolete. <br /> JASON GAITAN, EHS Page 17 of 21 <br />