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E. 41h St. Record ID# PR0514018
<br /> 9/2/2020 Program: HW
<br /> Photo 25: The following uniform hazardous waste manifest(000247767DAT) observed lacking a signed copy from designated facility.
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<br /> UNIFORM RA7AROOfaS 1.�4arablD Naiptr
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<br /> ITS
<br /> 12 um,
<br /> N°. Tape 4aaMilY WLNM. 13.Waste
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<br /> ITS OF MEAsuR£
<br /> N=Crrblc malars, ■
<br /> A=PdvI& V 2
<br /> r-T s(Zr700 Pounds),
<br /> Y=Cubic Yarn's.
<br /> is Yartle snood°'^ly he eapprted Ii :I
<br /> s,wdarges.
<br /> mibe..)waste strmm ddenllFietl in Ilan
<br /> 'der81 r>'N•ad—at be enlerFd hale,in to 4
<br /> egssenmeva o/are plgaardes dale
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<br /> 14.5111 IhnNng fnshYpanng anOAdditiarral Inkamafipn
<br /> I`-Aoodrlc inIorrnsuw necessary } D78400&p 1278('-r7
<br /> gfs widera5egene2fofs orplher ',100017_-",,30 #'
<br /> nungbera•amtaineraldes,bar .
<br /> nayuselhisspahemer .nirran raaarllnl li}•Fel,crYN rlr 4rv11'Drs•agcllry NlrtFX..rtty c,n ilnliel lnma{xseur l. pI,1 r 1rE.�lIt rsa n1lr lr.,.
<br /> rlalerlals,such a5 olernlp! tS. GENERATOR'S/OFFEROR'5 CER7IFIGATION:Inerehy aectare Nal>heoonlenis ofthacansignmenl arefuay antl ecwrale deurihed atrove11 dlh¢ilnlx rr. N r.rda I=Ir dl
<br /> afrcgravityofwaslesidenliPed e
<br /> 'marked aM labaledrptaarded.andare In all re as in pmpercpntllean ter transppA atteNlrg to applicaplp tlllema0pnelantl nasorml ppper shipping name,and^&a rtassifleA,pagWg�,
<br /> Elpwler.IceNly that the wnlallof this mnaignment c^nlwm to the lerrrrs al theattachM EYAAcknoµladgmanlMConsent. 9p raanml regolepons.If extert shlpm talre l am ata pni
<br /> tyfDquac'dlrtromlalion for which f Icernty thatMewaste minimisation Statement identifiedIn40 CFR 2fi2271af ell ams long.Wed E`AAftowralalorlhl(ill am asmall quantity generator Isw
<br /> ritganyallerrraN lacjfily z Gelreratorsroherors PnntedRyped Name I e
<br /> nalri/est lwrejac(ed wastes - - Slgnawrat,
<br /> i Mutdh Day Year
<br /> a'rd the speaHcapon of
<br /> outrof-service dates regnried �' � re.l^+smaeonal sdiPmanrs -
<br /> uradloenlerinloRry[ionln n ? Trans ❑Impart to)15. ❑ExPorl frorn U.s- Pcnolenbyleait
<br /> 7 7 Trans M eignat{rre(r0r exparg OnfyJ: D&le 110,5!4
<br /> pwler Adrnewledgm 11 'Receipt of rAatenalg
<br /> l r tv-don slalemwy In Trans }Pnntetllryped Name - Srgnelere 41(Ki7753p7SK5 2011
<br /> rerayors whc havenPl a - - I
<br /> Mmlh flay- Year
<br /> Transporter2 PrinleNr `` 616674K1BK 20:
<br /> waste MiYPad Name
<br /> I!lhey nava Ca'nPfred Signature
<br /> adon also coni rhe ~ "nth Day Year
<br /> and ISin proper I t 18.D$MPancy 011gA4518f1P 2C
<br /> o!!he shi
<br /> rrs0(lhisp�ra � }ga,DlspepancyfndieeuonSpace
<br /> ❑Quanlity ❑Type ❑Residue 0066866295K5 ]
<br /> shi➢p+ng name,and i Q ❑I Reject— Ll Full Reyenion
<br /> f respeds in propel �- OZQ38084*s11K
<br /> tlgcmmrr nbl � � fab,Ritemate Foolily(or GeneralorJ Mani Rsf ri Number
<br /> hal the Conreny8 of `I q U.S.EPR 19 Numhel 017T7%90JAK
<br /> 'menWCDnseni z U
<br /> Nlahctl this Patty Facililys Phone:
<br /> iq+lenl w iSc.SignatureefAtlernate
<br /> C3 Facility(or Generator)
<br /> � nzn9Bo64wx
<br /> he,fignalttre I i Month De,
<br /> 7g _ f N }8 kazardWs Waste
<br /> brayeEcr RepotI Management Method Codes(i.ewA
<br /> „ es 11: :1
<br /> 2 ous waste healmen{,disposal,anG recyCling syslams}
<br /> +ill a
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<br /> 113maybe � a,
<br /> and S�gning EF 20.Designated Facllgy Owner cr Operator.cetiflraffon of."'i of hazadous malenals covered by the manifest�rcapl as plied 4n Item 18a
<br /> PrinledlTyped Name
<br /> Slgna6os
<br /> MDnth Day Yaar
<br /> i EFA Farm 87i7p22(Roo.12-17J Previous edilion5 are obsolete.
<br /> GENERATOR'S INITIAL COPY
<br /> JASON GAITAN, EHS Page 25 of 38
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