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E. 41h St. Record ID# PR0514018 <br /> 9/2/2020 Program: HW <br /> Photo 26: The following uniform hazardous waste manifest(000247044DAT) observed lacking a signed copy from designated facility. <br /> 7 r <br /> OT=Dump Mrtlr, Please PNaia NPC, Form ed OM13 xo.x(tSCnea9 <br /> >W'4lhW ldNma.lafrefg}ggg 1_B�y�pfYni� 2PaperW 3£�ragx2.Y xaparee eruct <br /> ORIFDrIM RAZARepOe `Opb f4r644 DAT <br /> G' r'e1m-fr�'adm cars ' WASTE MARIFM r'-�`JB247i BG6 ! a06�1.'2-8263 <br /> r r.rr.sr..aa�c•ana.m e�.,,�.n.aar...e 20p' 000 wO`Z. W <br /> P,;WL lana, r Canmrtaarnmermen ChArtertazim mannan <br /> 222 Entail = UM <br /> Cargo Wku frank bt+ck 1, gapdnrri.CA 386 Flt-parr Ut P6366 (3 O o`3C7 <br /> ce.nr»Fnon.: 2f�6-S9B-8 r 3� �s.Trhro x�mmr <br /> roal carfsmmenearesr I r%^s ""Ela PfCINE-Grrs1IC*878G-Q0f7d"") G��179747 I�� �jrj Q <br /> acrre„repon quano-ties i <br /> V.5 EPAID xumhw <br /> rarres wrrh *ranrpwa x c�r Nome CAD9f1'?523433 <br /> Prtru,vn. f plXart EmfrmmerTwl uerMces <br /> urreaspPablyagruala 9hdF Nnw rtl Sroendmera tI5.EPA 19 xam0a <br /> a�pfable as espmaras. Cabn10&ToronrnenNr&Aullons L!C INflA00527625 <br /> I 6625 Old Part,Rd <br /> 'berow)for uta a.navr .! Portage.IN 46368 <br /> Eaar's Pnmw. 219-713-6184 <br /> %_ ft d$-DOT D .pp fk,vl,rv,Proper So"rU­HN s!CI—.lOMumbo. 1o.Cml— Ir.Toth 12.umr 13.Yr�le Catles <br /> MM and Padno Grnupraeny}l No Typa <br /> s) rc 1 rVan-RCRA FIamindous VW Ste Sol Id(DIATOWACEOUS EPR TH I rl ;j �' i 382 <br /> CLEAN UP) <br /> rt dtar eery <br /> w 1. <br /> TBfredrn(fern <br /> r oyfhe 7 <br /> sary a. <br /> ler <br /> 14.Spo-ath'andlbng inswctionsaMAeeVaonal lnMmration 00292750 153831 <br /> })9000175830 ! - 1 <br /> h <br /> Cantrell retained by gernenlar content agency sudlad"initial trans porler Lo add arsMbcdtute addllonad transporters on penef-aton he51a11. <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATM I herebydeclere WM the rant-lbor N6 consignment are luny and acoaralelf described allnve by de PlaPsr shippirvg name,and are dasstted,packaged, <br /> mad;edandiabeledfplacarded,and are in as respeclsin proper condIon for Tamp,amording to applicable agmaaonatand naLaNd govammmtA regvlafwM.li export shipnanl and I am me Primary <br /> Exporter,l_dry that the contents of this mnsignment wof—to the re—of the aUwhed EPAAcknmvledgment or CxnaenL O�G77t <br /> i ccrarp met ft wash minimization staramenl itlentifled in AO CFR 252.27(x)lit t am a large quantity generator!or(b)(if l am a mall quantity generalorl is W e. <br /> GeneremYsrOBe,ors Pr+rneNryped Nettle„ SlgnaNre ! Month Day Year 0165 <br /> )' fir { ll• f F` ri 1 J <br /> 1 16.havrr.nonalshipmImport[p U.S. <br /> enfs ❑Expod prom U.S. PonofenayieA _ O111 <br /> F ❑ <br /> I 11 =1 Transporter signatura(for exports ony): Date learvjpg U.S.: <br /> 22 <br /> ri K 17.TranspaYerAcknowiedgment of Receipt oFMaterlals 1 <br /> i WT r r Month Oay Year <br /> Jf- Trdnsponer 1 PnnfeGlfyped Name Signature O, <br /> �` Y <br /> IE 111 a <br /> 7TarWoder2PrintedfTyped Name Signature ' fAon4h Oxy Yea <br /> I! <br /> 18.Discrepancy <br /> IlK <br /> fes.Discrepancy lndiczlian Space Ouantlty ❑Type ❑Resdue ❑Partial Rejection ❑VW Rejection <br /> Mantlesl Relamnce Number: <br /> r 18b.Alremate Facility for Generator) U.S.EPA lO Number <br /> J <br /> U <br /> 4 Faci8lrs Phone: <br /> 18aSlgnatureofAiternateFaCility(orGerreratorJ Month Day YLU <br /> ear <br /> r Q <br /> 1�' z <br /> 19.Hazardous Waste Reporl Management Method Codes(i.e.,codes for hazardous waste Imatmant,disposal,and recycling systems) <br /> 0 1. 2 3 4. <br /> 20,Designaled Facility P,vner or Operator:Cedification of receipl of hazardous materials covered by the manitesl evcop(as need In Kom 1 Be <br /> Printed/TypedName Signature Month Oay Year _ <br /> EPA Form 8700-22(Rev,12-17) Previous editions are obsolete. GENERATOR'S HTIAL COPY <br /> JASON GAITAN, EHS Page 26 of 38 <br />