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811 Zephyr St, Stockton, CA 95206 Record ID# PRO539941 <br /> Date of Inspection 09/12/2018 <br /> PHOTO 20: Manifest with the generator copy only, LDR is also unsigned <br /> Please pont or type(Farm desigaetl for use on¢Ilt¢(12.pilth)lypawlder.l Form Approve)OMB Na.2050L039 <br /> UNIFORM HA2ARDDUS I.GeneimwlONumber 2.Pepe1N J.Emergerwy Respane¢PMrIe d' ^ e ^?"TbY�.try FLE <br /> WASTE MANIFEST _ tJ 1 I� -0 <br /> S.Genenrola NameaM Ma g Dress nerab �Atltl 1 rent Nan mad rgaaaressl <br /> � u, empg ur <br /> SrrrJ.lcYl G fKtzt.1` <br /> Gmersl,/s PAone:' US EPA IONumbar <br /> Pmre< <br /> l ra�evme,:ceeva�rNa„e s EPA ID N¢mb,r <br /> atillry Name arta Sile Actress U.S.EPA ID N¢mber <br /> PIAS '1 CF nr.J f -onto,, ' <br /> t I O D 1 ng Pmr>S1,, Nam,,Nazaroeasz.lD rvumber. m. t t I <br /> ouvplaeyl N,Go Oran-Y ww,y e <br /> 1 <br /> III <br /> td.SPeral Nana ng nsuucrons anOAad li,nal lnlorma"on <br /> ry«r;Fklr�rf.r:a IM3;;tl] t u <br /> 5.GENEftpiO SIO FERORSCERT FIC i0N III by tleclare Nal the ton ens( g entare full antl aaurateyaes-d above by th,proper sli Dpn <br /> mr n bel pW tletl. p 'proper mn0 on br banspo b' y gname and are Gassfea.packagetl. <br /> IE�poderaaNh Ifre.. <br /> M.fIM1 9 ppl'table'nlernal arta ut,naTona gOremmental regulaYons.if expod shipment and lam Ne Primary <br /> Tyro zaTon d f0 CFlR 2eterms of M1e h tlEPAA k owletlgmenl of Consent. <br /> I GenemlolsOMerols nn ed/IYPetl ame enl OenNfetl n d0 CFR 262 21(a) arge quanliry genemtod pr@)tfl amasmall guanlryg¢neratorl st <br /> moa ure <br /> n ay <br /> Ifi.Inlemalonal SM1pmenrs ea <br /> e <br /> o <br /> r <br /> y= 2 ❑Impod IO U.S. ❑Exp,n tram U.S. Port of enl/ <br /> ' � � —Trans hers nature lor¢rporls onl): ryexl � <br /> ' w 1]TmnspollerAukr�awletlgmenlof ReceVl of Materials Date lean U.S.: - --—— -- <br /> �TrensPOder 1 PrinleMYP�Name '- <br /> O rgnalure <br /> Mont Day <br /> T—POD.,2 Pdmetl7DW Name i I I ea <br /> ignalure <br /> Month ay Vear <br /> 1 18.Disvepanry <br /> 10a Oiscrepanry IndiGlion Space <br /> - �� I ❑011anlily ❑Type <br /> ❑Resitlue ❑Partial Rejection <br /> ❑Full Rejection <br /> 1815.Alternate FaciNy(or Generator) Manifest Reference Number_ <br /> LL Fanlil sPnone: US.EPA ID Number <br /> W 10t.Signature D(Allemale Facility for Generator) <br /> 2 <br /> �19.RazaMous Waste Report Management M11elhatl Codes(i.eMonth Day Year n � <br /> cotles tar M1azartlous waste Ire t 1,tl'pp I.nd <br /> 2. recycl'ng systems) <br /> 3 <br /> 20.Desgna ea Fatilty Darter or Operator Ced! r f A' <br /> P NDYped Nam¢ ceipt of M1azartlous materials—1d bY <br /> ave dby the marilesl except as noletl'n Item l8a <br /> EPA Form 81 8 gnature <br /> 0022(Rev.3-0E)Prev'ou6 ed'(ipns Ere GbsoletE. Month Day Year <br /> GENERATOR'S INITIAL COPY <br /> Tricia Dai, EHS Page 20 of 24 <br />