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800 W. Mossdale Rd. Record ID# PR0514467 <br /> 8/5/2020 Program: HW <br /> Photo 18: The following uniform hazardous waste manifest (016769300JJK) observed with no signed copy from designated facility. <br /> dr <br /> �y Kl � � �� � �1aY•MaCi 1e ream dMb No T¢50.ana9 2n8� <br /> r. l uwcm„���,,, ,�o,..�. 4 ,�a,=n..� 3dK I � � {°��yiy((1r.• <br /> sg4iTe RArIr.Est c'AL0002AO4oP 2P] , (am 424- 3 � <br /> r a MOr919'V�/IC-"Roomo.r�nsrwsuP�.r�w+ara�� 1 <br /> •P SW 14-M <br /> s \ r r, cww.nnLl7l11RlP 2M 2=ooze r1 s•,,,P IUvoTHFMv�oALe RD CA abs3n 4 <br /> i..o AVO woatn M e►mRorrn¢Nrru>'raRrrc[s � o 00 2 r 2 r r o a e <br /> ur,.,roenr: <br /> vim O�N�OE RECOYCRY BVUFEM INC G A R-O�Q 1 T S 4 2 2 <br /> e u^.t".sa soRy e.w.a er U.A FPA9Nwar <br /> rANNAOEMEArt.I14G. <br /> �- Iotrn HrpNWAY Ytl Masse itis <br /> Ki � r _ raau Frw. AZ B538Fi AXR000b21146 <br /> W. Ph US.trorp.gpypnf 9Pn•O.reaapty esn.rlatyU qua,OMniau 10 117a 12.Una 1a-paasi+e°daa <br /> F s Mar <br /> ryn o-anEn m rva. <br /> a k5 <br /> 'NON RCM WZAROCKq WASFE.SOUM tri Ort .A swrrpt 15. <br /> O <br /> � � r <br /> y 3 <br /> 3 <br /> ' ` _ <br /> I' f .� 1a.sped Randrng lnabuarn�ana.andltinnal lnm�maonn <br /> r _ £AfEROENCY CONTACT CHEMTREC 1-901.424•93M WOU TERMINAL.-CERf3 CS NAEHGR 981 171•HROFILE R"1 <br /> [ r <br /> a 16267.9iVRg�ROM FLOOR SWEEP• '•APPROPRIATE PPE EQUIPMENT <br /> GENERATOR'SlOFFERDR'SCER77FICATION;I hereby dedare that the wnlen%M this mnsignmenl are My and a—mW1Y de—bad above by the pmper shipping nanw,eM are daesd�ed,Pa[Fagea, <br /> _ mated andlabele,ilplacarded,antl are in all respects in proper contlibon Wrlrensport according to appliwMalnlamational and national govemmanlal regulalpirs.11 angor MripmeM ands am Na Primary � <br /> - Expwsar.I wafy that the w nlsolthk consignment coMonn to the terms ofdtu aimched EPA Acknowledgment m Carreent. <br /> JmM4y attltewasm minimlraeon statement idungedln 40 CFR26227(a)(iH am a lalgequanbty general-l)a@I(dl=aEmallquartl7ryganeratoglEtNe- <br /> /' Gene2 r VDFem/e P-m VTyped Name Signature snort, Day Year <br /> L ` Y y' <br /> m F! 18.lnlematie-f Shipmate ❑mpnd to U.S. ❑ <br /> I Exiled hom U-s. Pod of erWylaxit <br /> lTransporter signature ffOr expods only): D.We avhgu.s.: <br /> 1 W 17.TranspwWAckneVdgmentM ReoaiprofrlatffWs <br /> w y 4• Transpwrer 1 P-McUTyped Name / SignaWre Month Day Year <br /> 0 Y/ <br /> €1 — <br /> T.- rPOmed/Typed Nama Signature Month Day Year <br /> a K <br /> H <br /> . 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quandty ❑Type ❑Residue ❑Padial Relachon ❑TuVl Rdo'ban <br /> Manifest Reference N,Mban <br /> • 18b.Allemafe Fadiity[or Generalork U.S.EPA lO Wmbar <br /> J <br /> U <br /> FacKly'5 Phone: <br /> w 78c.Spnatora ofhlemale Fadi4(w Generator) Month gay Year <br /> r <br /> . - 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal.and recycling syslents} <br /> 2' 3_ a <br /> 20.Designated Facility Owner or Operator.Ceniricatfon of receipt of hazardous matenale covered by the manifest except as nded in Ilam 180 <br /> f- F'KnfedlTypedNama Signakure Month gay `tws <br /> r <br /> hh � EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S 1111T1A1 C04Y <br /> f R - <br /> FrI r <br /> JASON GAITAN, EHS Page 18 of 21 <br />