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E. 41h St. Record ID# PR0514018 <br /> 9/2/2020 Program: HW <br /> Photo 27: The following uniform hazardous waste manifest(000247122DAT) observed lacking a signed copy from designated facility. <br /> r - ----- - m,.a:umao,lesTr a.a <br /> - A5BURV FNvlor^.�.•�•—•- _— — - v <br /> - - _. aon rrrtam,xasz rawaur,ga t <br /> Form APproaed.CMa No.20540039 <br /> ' Pase7vna9TrS1YxpAe,NIFEST DF-L1a.al•!�K� <br /> 1G T' <br /> DAT <br /> 2.11 a aEn" 9"'W 82" <br /> UNIFORMHRDODS C,4D"247168 1 <br /> �,�,S,I,wwresa l�laneraM sa.manlne�a,eul <br /> s.c.1311 shame aw IAaa gnemew (isneerl6 Minsnen <br /> Csanrert 6 2lmmamen 222 Eest Forrnn 51 <br /> 222 East FurarW 3i wPoh,CA96"566 Zo2o ' 000 30 b 23 <br /> Ripon,CA 86366 <br /> Geo—w,mm, 209- 131 Lus.evA ID Nvmeer <br /> 11 <br /> Irl ramaam Nmw CARCM17974 <br /> US 7 !�0 <br /> �1 <br /> ri Ingenlsxn ISeaemrant0%••••ERI PHONE-Cc•a11DM N76B-0004••••) .I:rAlo nb 3�b, <br /> C 0982523433 v <br /> 7 7ranapodar2 C-,"Name <br /> OlRard EmArOrsmensll Services us.EPA10IN- 1 Zo1U — C70`2,`� ?' <br /> e.pestgqnnarae Fa.�r Neve eae sae mare:: 1NFIMI.47B21 <br /> [:overrianslranmenlaf Sraufons LLC <br /> 6625 Clld Porter Rd <br /> Portage,IN 46368 <br /> Femu yPa,, 260-240-2481 52.uNt 13.wasw cedes <br /> - H9aM. ea 11 1 ,ia— Fr9N0o.runreYYPa 1D1u-a1d <br /> aMPtlS-Tn ;A-0dnH <br /> I.r-m( naPJ <br /> WINc4 <br /> 352 <br /> 1Mon-RCRAH.MousWasteSalad(DIATOMIFCECU1 EPRTN <br /> CLEAN UP) [1 <br /> a. <br /> 4. <br /> 14.Special Handling Instructions aM Additional Inromlalwn D84747 SO 159668 11 <br /> m 1)1000175&30 Z- lI Z /j 1 <br /> agsa <br /> t7araiar 001113maYasadly do Inl6sl aortorto add CHS Substa""adQl6onal <br /> CarYLract relnad by gen ""Paden on 9snsnt[,n hehall <br /> mien"rtpdand a[LaretelY desn7@ad ahomtq tl�ePl Msh,II name <br /> 15. GENERAIDR'SIOFFEROR'a I.ERTIFICA71aN:Thereby denlare that the canlerus of mrs wnslgn triable internatimaVand national governmental regulations 11 erprul sliW^Rnl andlam d,a Primary <br /> maned and labelsdlpfawmed,and aro in all mspecmmproper caodaian fare heat" dh.dEAAa,- lOf Conselrt <br /> Fxpa,m,icvnfy Uwl the contents o{II eonslgnmele eonfom mNe farms of Ehe attadled EPAAaenovdedgman Il am asmdll4aanthygeneraW)-Gua. Dal Maar <br /> I rerlify Nai the waste minimization slalemanl identified In 40 CFR 262.27(a7ltf I am a targe 9nantry 9enelaWl«�)R ,I <br /> SignaWre - /' _ <br /> GeneralorslOtferWs Pnrwyped Name II r <br /> 16.InlemaJIMA ShipmenImIYon Ia U.B. Dam <br /> ts ❑EY-0od{yarn U.S. aenlryrUS <br /> ❑ WIU.S.: li <br /> z <br /> 7ranspulersignaNre(fore>ipods o+vV): <br /> w 17.7ranvporterAclnb+Aed9�'dot Receiptof Malarial" µ a1 0aY Vear <br /> Signature 1 <br /> r Transporter 1 PrtnledR•y�df,Name / <br /> a cl jL}t- C •1 I;E 5 naWre <br /> Y Monfi ^0M Year <br /> z TranWors r 2 PitladiTyped Name h <br /> d� <br /> F <br /> 1 <br /> 18.Discrepancy ❑ Residue ❑Pa lial Reiec4on Full RejeG On <br /> + iBa.Dlapepanry lMlcation SPace quantity Typo <br /> +II MaJI Reftlllnm Numheti <br /> 11,5.EPA YO Number <br /> i8b.Alternate Facility(or Generator) <br /> J <br /> V <br /> LL Facility's Phone: Montt, nay YeW <br /> ' w 18c.SlgnatureafAflernate Facility(or Generator) <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes{i.e.,pedes for hazardous waste Veatfrlanl,disposal,and recycdng sysiam3l <br /> 3. <br /> 0 <br /> 20.Designated Facillly Owneror Operator Ced lIC800n of receipt DI hazardous maledal3 covered by The manifegl e"capt as noted In Ilam 188 Month oay 'ferry <br /> Prinledflypad Kama signature <br /> FPA Form 8700-22(Rev.12.17)Previous editions are obsolete, GENERATORS MITIAI COPY <br /> JASON GAITAN, EHS Page 27 of 38 <br />