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1022 E. Frontage Rd. Record ID# PR0519099 <br /> 8/24/2020 Program: ER <br /> Photo 4: The following uniform hazardous waste manifest (0 1 8529233JJK) observed with no signed designated copy. <br /> Aleas4 pdnl or M.{fpm deai9ned for use an e61e 121atch)typewriter-) Farm Appmeed.OMS N0.2D50,0039 , <br /> 1, J UNIFORM HAZARDOUS I'Ga�elara <br /> ID Na li 3.Papa 10 3-Emarpenry ReaPmaePMne {.--[T-12 N]umbx�j 1 �/ <br /> WASTE MANIFEST GAL000:'J 13k:4 I "' - '-'- 0,!852,9233 JJK <br /> t` T .. - 5.rlerremeYn NameaM Mefllnp AAdraaa Geremldssu Add—"d a Rarest rrn.11arpa W—) <br /> (ALL tAr'i <br /> ��RI)MiWE Al2CW7 CA 963ti6 <br /> 0..ke,Ph—, �69Fe6GL <br /> 4e I ��" usENumer <br /> MENIAL 9EFrYN;Es t:A PAtD U U:�bI� <br /> r rrnapaaar7o��NemR U.9.EPA10 Number <br /> W�IRLDWI1)E NEC0W.rer:tiy^;IFM IMC f:A R 11 n r,1 T-1-117 <br /> Deepneletl Fe Noma Wit!lice wires- u-e,EPA ID Number <br /> rultq rE�u c <br /> ya0E1'31119I <br /> }UAIA ti '+d:sk� A2111597r1 <br /> 00051 <br /> IF' <br /> ecdl .Phoas. I'.721')S-0.L JlI2B <br /> ga 9b.U.S.DDT Oascni'vi Ilndpflrq Pre.,Shlppirlg If—,Hazard Claea,110 Namur, 10.CenlaNara 11.Total 12.11na 13'rvasle CA. — <br /> HM and Paring c—' P(ll any)) No type 0—itly WWoI <br /> INON-kr2kA NA4ARL70u9 WASIE.`31i rJli 6kiLII),PAP::H HLILF' <br /> I- <br /> z 2_ <br /> 7 <br /> a. <br /> ax` <br /> "Aa- i45pedal Handling lnslmcbons and Adtlkional l,b-1on <br /> a i-Ai)1.15VJ, .'-*424-93W WOES TEFFM{NAL' •PRgF rL(:�J[s] 1626231`06G,11-620(All 9UlSD <br /> f@ "APER fir to. f a1 nL+.�tWIPNENT <br /> 73. GENERATOR'SIOFFEROR'$CERTIFICATION:I[—by detlare that the contents of mis consii arelully ane amurateiydescribad abovslry Iha proper sh,ppng name,and ens dassifed,PeU9e4 A <br /> marked anti laheled/plaeartletl.and ere In all resp0ets in proper o ddlon Mr transport accoNing m app6rade international and`,0603919ovemmmbl regWadpa,H aeportehipment andI amnia 1o"'y ` <br /> Eapoder.I certify that the oantents of this consignment anform to the I—of the anasehed EPAkiknaatadgmenl of Consent. teal - SI I <br /> I ceNtylhat Iha waste minim1z45on statement Identified 1n40 CFR26227(a)(if I am a large quantity generaloq m Ihl 0h am a small quantity generator)Isaac. <br /> Gemeralofslptrerots PdntedlTyped Name Signature Month Day Yaar - rr <br /> 16.Intemaaonal SNpments - <br /> F- ❑Importto D.S. ❑Export f,,,uS. Pori of enuyleaiL - <br /> Transporter sgnature(lareapodsonly). Data leaving US.: <br /> TranspoderAcluroreedgment <br /> of Rewipl of Maiar <br /> Tran sporter I Pnrwiv[ypM Name Srg-N. Month Day Yea, <br /> tl, ar <br /> spaderl Pnntedfrypetl Name SignaNra Month Day Yeaiscrepanty Discrepancy Indication Space ❑pnbi ❑Type ❑Residue ❑Partial Rejt. D Fvh Royecllon <br /> Mantled Reference Number:Alternate FacilitU.S.FPA ID Number <br /> y's phone: ear <br /> ignature of Alternate Facility(ar Generator)zardous Waste Report Management Method Codas p e„codes 1*0aaardouswaeta trealmenl.disposal,and recycling systems!2. 3, 4. <br /> _ <br /> 122.Designated Fsally Umer ar Operator.Cenrfiralion of recelpl of hazardous materials mvared 6y the manifest Ber9pl as tided in Item 186 8r <br /> PnntedrFypad Name Signature Month 0y1 Yaar <br /> IPY <br /> EPA Form 8700-22(Rev 3-05)Previous editions are obsolete. GENERATOR'S INMAL COPY <br /> JASON GAITAN, EHS Page 5 of 41 <br />