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1022 E. Frontage Rd. Record ID# PR0519099
<br /> 8/24/2020 Program: ER
<br /> Photo 1: The following uniform hazardous waste manifest (020383422JJK) observed with no signed designated copy.
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<br /> Alease Pnat or tYPe. 2 P Je 1 M 3.Emerym leespwce Phan A.MrnrlrrrTr¢1,q umMr JJK
<br /> ^•• -_^°"^""" UNIFORMHA.7ARows t.GenrrrmriDNumeer 020.7 34
<br /> ..-�r °„o..°r r-._,. •.„ I. CAL 00023%364
<br /> 1 (800)424.9300
<br /> -vHr=••,,,,, WASTE MANIFESTGaneralols 5Aa PGNeva VA erfremMP.n maHrq atltlress}
<br /> a„..a.r.-^°•”" ' s cenGILL FJfPNE39�naaeereee I
<br /> °r,r unm•:• 10.21.1TAGE ROAD CA li
<br /> w RIPoN ,
<br /> p,A°a N,i. Ueneralor'e Phme' 1065998662 V.5
<br /> D0 0 2 EPAiD,: 2
<br /> • 6 Transwaar 1 caaoawy Name CA81 T 7 0 3 6
<br /> RONMENTA1 i ,
<br /> a° SERVICES OIL ENYIIS.Era tD NNmber
<br /> .r "^' zTmnsowler2CartwanyNama CAR 000175412 —_-
<br /> WORLDWIDERECOYERY9YSTEMINC. us.Fvn lD Nembar
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<br /> 13600 US HIGHWAY 95 05365AZ R 000521148 1
<br /> YUMA AZ
<br /> Fael'i ,Pkm. 928 49829 s0.em,rai^en n Tmal 12.UM ta.wl,,W dee
<br /> eb U S.DDT Desalphan plewding PWw Sl png Name.HazaN Claes,rD Number. NC_ Tylia OuarNry WuVN.
<br /> HM and Padang G-Ple anyl}
<br /> n •wl.Y w u r-srr°m r o I NON-RCRA HAZARDOUS WASTE,SOLJD(PAPER FILTERS) p M P2
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<br /> nw^•^•'"w.rrtrcmlrr=hnnp'�•'""r nre'^`P"r"-= � 145petlsl HaMting lnSWCGonsand AddNo�ral ll„=w..�,..=I,•.,uan.anr:.I,rreNarKrl.rceaq lCERE9 G`S �'PROFlLEN461'.182823NR581L82G V
<br /> u n ra a Aw wearw r�rr ra' 'x EMERGENCY CONTACT:CHEMTREC 1.9Dp4149300 WOES TERMINAL'
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<br /> APPROPRIATE
<br /> ny PAPER FILTERS
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<br /> _ and aze ela85dled,packaged.
<br /> 15. GENERATOR-BJOFFERDR'SCERTIFICATIDN:Iherefry Eeda2 that Ne wntenls of lM1ls aSlgnM awn IIPaMeilnlamauonal and nali9naIgn'l_—Wl"Il,t rtStllp—N and l a<^B+B Pmnary
<br /> marpeb and labelmlplacaded,aM are in all respec451M1 Pr^Far condi0on la banspnn a
<br /> ,r,nra,°°a mndr.mlu x(w eL nm a�us,rx,nry ran,.maAS Pr�r FrpPn¢rlce+aty that he mnteetsorrhls oonsignmenLmn}ermWtha terms of the anached EPAAa^naled9menl al Consent. rotor swa.
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<br /> 'In.aedarrvrn I�dfl'Thal ll,e waste minimization statement identified In 40 CFR 26227(.){lf l am a large gaanti79ene+atml or(dl(dl�masmal�quandly gene 1' yAanth Day Yeaz
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<br /> Ifo erpnds Date leaving U.S.
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<br /> OMonm qay Year
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<br /> 18.Discrepancy ❑Fvtl Reletllon
<br /> OlscrepancylMiwllan Space El Type
<br /> ❑Residue Pal Rejacuon
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<br /> ❑Cuan6ty
<br /> .n I..,vu.nrJ rll xJsr chary,•.wr loth n I,w.
<br /> +al to i Manlfasl Relerenca Number
<br /> =ly u=:;�.,' „ Lyln,Wrcr,meL�eme wn U.S.EPA1D Numbal
<br /> _ r .xr.e ul+.hurldh'nrnmA.u } lab.AIlemale Facrhty for Genaratprl
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<br /> u Facdlry's Phone' Month Day veal
<br /> C3 fac.Srgnalura ofNtemale Facility(or Gene[alor(
<br /> :f aa.C�un,•dI n.Iektr fm all rsdLnLz L'll u'urcdED
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<br /> :e v�•n'rr�i°j1M1101"` "r" b�� �- 19.HalWaste Report Managemenl Method CDdes(te.,codas for hazardous wasle treaVnont,disposal,and recycling syelomsl 4
<br /> 2 3
<br /> u,W s N-wd Irmer<rr.IM, pp.Designaled Facldly O"er or OperNi Cenification otreceipt of hanrdous materials Me——by the mandestoxtepl as ode,In Item 100 Manch pay )ell
<br /> Signature
<br /> PrinledlTyPed Name -
<br /> GENERATOR'S Hi COPY
<br /> EPA Form 871{Rev.12-17}Previous editions are obsolete.
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<br /> JASON GAITAN, EHS Page 1 of 41
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