|
1022 E. Frontage Rd. Record ID# PR0519099
<br /> 8/24/2020 Program: ER
<br /> Photo 11: The followin uniform hazardous waste manifest (016774301JJK) observed with no signed designated copl.
<br /> ' Fam Appmvad.GMBNe 20%22'
<br /> y� rry. l.wm•" ReesepnWor .tFamdesignedWanean awo 12 tmone
<br /> Kw mralra.raav n.
<br /> .e„.....�,,-_.r,,�...,.,,.,a,�e�, 'rr-�an+Wir�"'�- ^. �, w-.•I•R akr,;w,-a_,y"1,yjr - �1aYlJ- I Gese—.1 N2Pa9e1 1el ].F.nw1994emC.sY1NnW^ee4au�nxra racxlNa NwNnAM1.
<br /> A „UNIFORM HAZARDOUS ALUUU73136fou
<br /> 2-v
<br /> WASTE MANIFEST
<br /> �. .y:. 'rwµ.Jar.rNw Germmbru See Mdv56U 91k1rntNn nyatrq rdNaaSt _ -
<br /> �• 5 Genwebh NINp
<br /> ].D:':FHuM&AE ROAD 953"
<br /> .aa�a+••J.n 1 H13't5N
<br /> s,.�.x ':o,:.►. '..�nr,m..,.r.r lna.r.Ear.r•n.i. car,ernlarranona 209 5916667
<br /> ,,,
<br /> Tr.n"A8me !]61aZ 7'r GJtl
<br /> A38 HY Wmo.C�VIFt'JMMEN[AL 9ERNGk-i
<br /> .w M.r:-Mn.raa.,,'enrsi" -' 11 S.EPA IU Nurn.n
<br /> _ .r.. rr Q ., rTranen«ter2cmnpenr Nam.
<br /> weal rn.w.amm Nm w:eV"au.rM1:rWnt a.li...,xu..-•' 115,EPAld NVrmtn
<br /> S.oeefPlMed ami�ttyy Name r,tl-sx.
<br /> 637590UFM YE H!LECAVENUE
<br /> 4E�NC
<br /> 1FCAD037030983
<br /> LW ANGELMI CA90056
<br /> Feou Phoney (72312 7 7--L%0
<br /> ,mm a a.r.1w.,. n ..,.n •.- "'n-rn.,W°.r,.........n as MU5.DOT Uescapeon(iido'in proper Shlpping Name.iia ir,Cl—I4 Number. ,e GontaVen QM1 N 1N2rNd 13.Wsak CRd,'.s
<br /> and Pecln9G."plllenyll Nn, Type
<br /> F1Lr c t
<br /> Jr ON RCliA 1]Ol15 WASTE.30WUD(OILY yt]I.Y
<br /> Ha
<br /> ., ..aMxrry.,.�,.w ... n.,.r Wrrt,.,a�wmnr w:r.T l•y. s P
<br /> ud AUL, ,•1'z.n, Yrm,.. W
<br /> Z 2
<br /> _ r .i mvJrx M�hrNmn,Jm,rrr U
<br /> r.r m,r NnrarikrJ.r: nrn-1YTN•.r�M�smr4 u'�sdi b rJp.%fw-iq
<br /> au d•r a"ud.nWma'r mnns.W A9,nnnW r dr.�M1�L,i ru'Irrc.�rrani'ax 'Nu
<br /> .aa.,4 SI.I u,lx rPt.+.rr aCw a m
<br /> nln+.J•�.,Y'W,Nuenf,rnaW M.Nc ). _
<br /> q.m arl,e+w lir wr.v,wn HA vnHrei i,.J.,>sr.urn::,Ic rnw.-dr"of Wanc ayn.nJ h[user.+.
<br /> f,rw•m5�rma.Y,•...mrul,n.N[aulrl•l„a„�W c•e,v.:.i,r.ry'1r1r•ro.:[®¢<otatl tllrl,r.l:v.f..Wm
<br /> a7rr.rr,M1.ckuY!x,HSru'nr me.srJ h.:r is mW rxe:rv.w+i.s'.nmF^'.�Wa.m.Cmnaar=Ub np,nUk
<br /> Jar `
<br /> I
<br /> .r,,.nsr,n,xru:a.was.w1 rn,r•,�,r.1 e.prn�ti'n'aknl rrrrrw 1n lulu0.'„+"`rd mren.e.'ra�Jamnu erW
<br /> .ui/tlr+3.n:Jrnuru,lr,mrr:au, rtl-•rglnsspr..anYlnP'Wx'ryedaM1ll�rsoli 14Spe lHandhKIr Cfi0R9aMAdaieOnaln,amaeon
<br /> erba..er..rau�n.rrm.,., ,rtil�.>r....wa'.uLxc�sw�rme�a�,n.r,. - 9&1:111"PRUFN.E/41k11 API 1"5 S.PAYER
<br /> fMERf,ENC'rUANTAC7:cHEMTREC ]:-BOa424-9300i11�
<br /> FILTERS^Pi�GOOCIOr1f7iB''APPROPRIATEPfFMONALPROTECTMEgUIP1114M
<br /> a cosi ddmdr W kddy rtNrY w an,'rrr.r.rka,nm' anSw�M1u.M M1..m m.prnr m ,1wa rWr r.,M1
<br /> ,r,yn.,7„mr,:n,.rn,.nrm=Vrc.m„wnr NY Woes r:•r,wlmrac n.a. J< J.,.,,n> .►
<br /> r,o.mpk„a mhs,laa,lolr.,+D'ru- rI m h Yname.aeeuedaurrred,Pacxa9ed. -..
<br /> 15. GENERATOR'SNFFEROR'SCFRTIFICATION�Ihareby datlare thalthe contents al thismnsignmenla lot and acwraleldunhed allo.n�r��l�a�awal9„�biIamend lam the Alinlary I" �
<br /> marked aM IabekNplacaMeq and ae in ell respects In proper odldilpn ler transport aaArdlTg to applicable inlamaaonal alyd nalionaV gove
<br /> n,.prr.Wg4 wurrl n'o,rar.+ma WbrGy Lma,rdR ew IMrr a a..ym.a�weobi� ExpoRer,Icersly Uia1 the mnlent5 of Ihis wnsignmenl mnM1mmWthe terms olthe aaa[hed EPAAchnowleagment of Consent i
<br /> ��.July meen,wrw,knr nrrrm,n-,rrr--y.11plrn l.r+rxi�r.nrn rn,a lnmwr,"nrc.rr,F.amr:`n' Icedify that Na x-asrE minimization statement udenef din 49 CFR 2e2.271al lilfamaiarge 4uantity gSannenraatarfa46t(Illamasmae quantity geneawr}a true Monx, Gay Year I
<br /> r �ratNsrGaerors PfINM1T,yped Name i"Wrc ! ,
<br /> Ili-Inlamd4anal Shlpmanls ❑Impotlt9 US_ ❑Fiwnfmm U.S. Ppd of aneyVexR - iy] 1
<br /> ' rufr.,.ele,nrY M'r.-,ecJu u,lal:a,ria,un lnrcW x'�]Fs'.,.1 de:lnnn.Ifau�.r:-' F
<br /> tllvna4 11.cr:rrr,nmhr�rxq ln,h,n.rMOM1,mnrlir;WYrv.'e In e.rretl rhs.rpJe Irma.Fmnr„'. Z TranSpoaer aignatVfe(�reFyOrIS ORy}. DBM1BaNnQUS_
<br /> r•A n.+n,•1 rn roc Inns',1rm,rahmmvl•ore rrr hr en nnml ImaR rrman vsan ib raaurci:� �.
<br /> w 77.TranspoMr/+r-rrerrwledgmenl of Rersiplaf Materials Mal1h pay Peer
<br /> Transporter 1 Prinledjypad Name SigneNre
<br /> qw��fwW++w lmr wnu�Ld.r mrmlrr.nNr<n.,colon rncrr n'„Arak,nu rv.,�,rl�m r.,.�a:r.�'.ra,M1nr rn SynaNre hmnlh paY year
<br /> irWrnns,n,Nrtr a rm,Mrr ra,b m„nk,pm pinda,en mr rr•R•.rr.,ecu.,ra oumLaw rakr G Transporter 2 Pnmedrfyped Name
<br /> kr.Jih 7.nr,:r,.,:.r,V. ,:..'n,hrlLrle l,ul"-n, J,nle:pa,ri,...„nf lrai•.P.irP.vtl'NrJ. O_' _
<br /> H �
<br /> 18.Discrepancy
<br /> ❑F,R Roe-bon
<br /> lea.CEscmpanry Indication 5paw �OuenfTy ❑T'1Pe ❑Reshue ❑Partial Rejeroon t '
<br /> [.n.andarcd r,d...lnamry...mlvnm:huk m n,M1 4rnnr enJ,.P n;,.,I:.;._,+er r,r ur Ivb..
<br /> 1k,mhi mhemMOW Raterennm
<br /> .6mmCo-r
<br /> nc hone.11,14 hmaamn 11.5,EPAlD Num4er
<br /> 'A1•A.s:i.rr ma,nw,.t,�aii R,lf S v,,.•l w.nxr x,dWn mrlix'rl'x chllyr n lsnlwae pla,awxl lab.AMmate Fau1401 Generale')
<br /> Lsl arca r F.r�I.,rd a,J ph'nNm nr aflprv:burin tlm Li full\l.l 7111{}},!'-)�1 M,+Ymal lAa J
<br /> L)
<br /> I I Faclliys Phone', Month Day Year
<br /> w 180 Signature ut Allemate Fadlily(or Generator)
<br /> .urn nhlnli7a11x.namrl.krsul.Llbvinn wdr en Nrbk Arca 04AnnaaapMaPa nvrad... q
<br /> brJr.n armpr7lrbxa ndlr Amnn.wrnrrMmdrwdeypldkxhk,YN:fM IID1AaM SIldrrc . Y
<br /> nraa:.na.y am a:..,n,a xr ucra,lh N.•P'3^r.a 4rd11 aznazm ox'hrp A lec mq•nsr u1 clxr rix• 0 19.Hazardous Waste Report Management Melhod Codes(I e.codes 101 hazardous waste ttealmenl,tllspesel,and rerydingsyslemst
<br /> I. 2.
<br /> 0,1 20.Deslgnaled FacildY Owneror Opelatoc Cerbfratbn of r,oalpt olhazardoas matadals covered by tha mamlest except as noted In Item 18a Month Dap
<br /> PnnlWffyped Name SlgnaWre
<br /> EPA Form 87CC-22(Ray.3-05)Previous editions are obsolete. GENERATORS HT1AL COPY
<br /> i
<br /> JASON GAITAN, EHS Page 11 of 41
<br />
|