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1022 E. Frontage Rd. Record ID# PR0519099 <br /> 8/24/2020 Program: ER <br /> Photo 3: The following uniform hazardous waste manifest(018237115JJK) observed with no signed designated copy. <br /> -- .-. Faml <br /> UNIFORM NAFAROOUe o1ae lSo_2a60-0079 <br /> AI9aBe print w .Farm des lot rM 41 ei'b 12 y . <br /> 1 Gsnr�N Nurber i 1 d ].Eme,gencr Respmsa Isriar a 1 I <br /> WASTE MANIFEST CAlt'00:34364 .1�1v JJn <br /> 5 Ge=,¢rabls Name aaa HefyAaheu randtlole Z,YY adA'en Cd Wlrrenitl�me.r9 eddwt r <br /> ...., ...- .._r..,•._.r..,.. -..: I,. 'rafAOE RtIAia � <br /> - <br /> ce�e.alraPaerse: <br /> s+mrsnPrmr.+co.^parry Ngmw -.-,NMknTAL 5E1tYlCE9 Us. I <br /> R�rToae <br /> i Txnsyortv 2Gompny NameUS FAI YI Nulfler <br /> -- Vl Pr SY51 FIM INC CAROOOlT54� "— <br /> 66W GS HeONWAY95 <br /> YUAAA N_ AZ R Fy 0 0 5 2 i k 4[i• <br /> Faoo a ph—: (17W"4-"28 <br /> ga ah.U.S.COT Oaselp)m Owleaene ProW Shlpprg Name,Heard Class,10 Nurim, 10.Containers It.Tata) 12.Ural 13.Yruk Codes <br /> I.ar aro rnow(ea^y11 Na Type n-lay wwd. <br /> z 2. <br /> c� <br /> r� <br /> J <br /> laha'•ekru,.,.. 4 <br /> loo,'..' 14.Spate Handing InsWCUow Additional <br /> Inkrmatlwl <br /> as•„ ' <br /> _I;GENCY CONTACT CH[MTl7EC I-NOU-4^4-9300 WOES TERMINAL C£RES C.5 a PFk F' � <br /> APER FILTERS' -APPROPRIATE PPE FQUIPMENT <br /> 1 <br /> GENERA70R'S10FFEROR'S CERTIFICATION:f hereby hedare that the—tents of this e^nsignmant are fully and awuretaly desc lbed ahove by the proper shipping name,aro a+e c;as,S,6ed,packaged, r <br /> marred aria fafxledlplararded,and are in au respects in proper condition for transport ermrding w applicahle inlemaeonaf aM national gmammenlal regulaeon_s.If espoR shipment aM I am the Pnmary ' <br /> Exporter,I certify that the wmenis of this wnatgnmenl conform to the terms of the attached EPAAcknmvledgmenl of Consent. <br /> I tervy that Ihawasta minimization statement Identified In 4d CFR 262.27Sa)(itl ama large quantiygan..Ioe)or(b)(if I am a smai quantity ganealal m true. <br /> ery,y„ Generalors101rerors Printed/Typed Name Signaorre Menlh pay Year <br /> afWe,;Np s, <br /> - <br /> 41 <br /> Ifi,Intema6onal Shipments ❑Import to U.S. ❑Export 4mo V. Pod oFentryladl'_ <br /> ....•r.,, i <br /> = Tanspoderesgnature(for exports only): Cale leaving US., <br /> ]X[17 T2nspoderAcknowiedgmem of Receipt of Materials <br /> 72nsporter i Pnntedrryped Name SignaWre Month Day 'T <br /> ,.., rleMaT+asaa s,K a+al)t,msa n, Q h-n <br /> aer6+ R z Transporter 2 PrintedlTypad Name SigwNa Month Day Year <br /> d <br /> K <br /> H <br /> Ifi discrepancy <br /> 16a.Discrepancy Indicali Spars ❑Ouantily ❑Type ❑ResidveI i y <br /> ❑Partial Re action ❑FuN Re edion <br /> Manifest Reference Number <br /> 1r +.y'r rhnr„rm,r"„r;"^,n„ 18b.Alremata Farility(or Generator) US.EPA 10 Number <br /> J <br /> +w' a <br /> Fact.&ys Phone: <br /> w Tflc.Signature ofAllamate Facility{or Generator] Month Day Yeaf <br /> a <br /> z .:. <br /> IR.Hazardous Waste Report Management Method Codes(i.e„codes far hazardous waste treatment disposal,and recyding systems) <br /> Eh. 20.Designated Facility Owner or Operator.CarlificaGon of receipt of hazardous maledals covered by the manifest except as nded In Item Ida <br /> Printei:UTyped Name Signature monz 0" ear <br /> EPA Form 6700-22(Rev.3.05)Previous editors are obsolete. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, EHS Page 3 of 41 <br />