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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,.. 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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 />