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800 W. Mossdale Rd. Record ID# PR0514467 <br /> 8/5/2020 Program: HW <br /> Photo 19: The following uniform hazardous waste manifest (016769299JJK) observed with no signed copy from designated facility. <br /> I UNIFpRN I'WNr�s r Qer�r.'�ala vM aMe rus 1t1`�m�s I � 1 <br /> HASTE xIANn sur r.A I a a o z!A.o w '�zae�on r a SJK <br /> Iprawr liom Tialer �g s P�Ha 142a <br /> $ G PS-13096O M 1A(M-M I F RD <br /> S2a,pp.r6 U1T1�R0V eve ane rn.m.r <br /> l <br /> ~IRIIRir VIII,ryyrpOI11ME MAI YINIGE'1 a s�°�,141��4�2 t T O]E <br /> 5 har+els,k �} <br /> 7•a Cas. egs. `m r Trupvy'2 torp�f Mire <br /> e- <br /> �^ yfy� <br /> /� 'I" a I�VO•� min.. - t <br /> '�'1 ti!•� 47769bCIE"WYLE AVENUE <br /> LD®A113ELEM <br /> cYx `app-yr+ A 3 <br /> ca sa,a.. (�:3JT7716pp r,AD01a70304 ' <br /> as, r. sb. ee.v s.Ibr I �,;n,z <br /> . <br /> Wes r rrM ne eadw Grp rl.nxn n,aMm, 12V <br /> T - A9 E 'Pll lf3(ryP�A^.EI 162 1 .� <br /> P <br /> fes <br /> ,t ) <br /> 4 <br /> t 14.Specialm ming i-inn ions I ndmdtiCnal Inronnason <br /> EMERGENCY COWAGI CHEW -C 1-80[)-4249300 WOES TERMINAL'CE(4ES CS WAERf3M 961;lTi PRQFILE*061' <br /> r}- 5;h?t-:fi 7(;RFA^..F-1`500-CM9440-7•APPROPRIATE PPF EQUIPMENT <br /> 1 -7 :1 <br /> GENEAATOR'SfOFF17ROR'S CERTiriCg71PNI herel ydedare that the mntenls of Il is Consignment are felly and accurately,d1—kned ah6Ye b'/the proper,IAW ry name,and are das4rfied.Pad,aBed. <br /> /�z marked and nity ihat the rndlpiacarded,and ara in all respect In pfoper condition for 12nsporl aCr�vrding to applicable interneb—1 and nauonat gCvemmenla4 regulations.It axpl IIIipmenl and lam the Primary <br /> C w Exporter I Cerey tnlan=s yr this conalif—ant conform to the ll elf the anclled EPAACkr,,M dgment M 0-writJ aarnry that the waste minIm ban saga rl Identified in 46 CFR 262.27(a)(it I am a large quantity generator)or(b}(If I am a smalf quantity generator)Is we. - <br /> oGeneratorsrOaernrs PlfnledlTyped Name 59na1ore MI flay Year _ <br /> r I6.Inlema(ipnal Shipments <br /> r ❑Import to U.S. ❑Pxparl Erom U.S. Purl of enlrylexit <br /> '. :1 Transporter signature(far expods oniy) Oate learng U S.'- <br /> r +r17 TransporterAcknowiedgmertl or Receipt Of Materials <br /> w <br /> L� Transporter 1 PnnledfTyped Name �/ Sgnalure Mose, flay Year <br /> Transporter21`-Ne lTynac Name Slgnathee Month gay Year <br /> Q <br /> 4 r f= <br /> . <br /> r 1&.Ofscrepancy <br /> J ISa.Discrepancy indication Space ❑Quantity ❑Type ❑Residue L1 pfi't lRejection L1 Fu6 Re,r twn <br /> •� <br /> Manifest Reference Number'. <br /> �7 186.Aitemate Facifily(or Generator) U.S.EPA 14 Number <br /> U <br /> . <br /> F1 <br /> ra acility's Phone: <br /> 1 W 18c Signature ofAliernats Facility(or Generator) Montt, flay Year - <br /> 1- <br /> 129 <br /> a <br /> f l 19,Hazardous Waste Reporl Management Melhod Codes(A.,codes for hazardous waste treatment,dlsposal,and recycling systems) <br /> t n T. 2. a, 4. <br /> 20.Designated Facility Owner or Operator:Certification of recall of hazardous materials covered by the manifest except as Ilded In Item t Be <br /> Pnnled/TypedName Slgnalurff MOn Day Year �� <br /> !'� r EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S MI'll CGp`( <br /> �I <br /> 1 <br /> f <br /> Al <br /> JASON GAITAN, EHS Page 19 of 21 <br />