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E. 41h St. Record ID# PR0514018 <br /> 9/2/2020 Program: HW <br /> Photo 32: The following uniform hazardous waste manifest(000217748DAT) observed lacking a signed copy from designated facility. <br /> 3 <br /> V <br /> � ]3a <br /> Please pool a type(Fomr tlrsg.tl Iw use on eGb(12�IiM)ryp0a.+ller.l lAppmwd-0M6 N�-205e6'n3g <br /> UNIFORM WIZJlR0W9 t.cer,arab mFamas 2Pagerel 3.FnA'9�aY Reaeoea Prue ♦MwulniTM�a mom• 1 <br /> ,Z WAS'l MMIFES7 �i`aN.`A 71 ' , I R4lfi i'.H:'•.: Y <br /> 000 _7748 DAT <br /> '. ' OKI:,t 722 Eset Pourer F>1 <br /> [D/ ralpat.7' OLKVI ME [ABx"%E <br /> - r wrs Prwb: 20l 15f1H E1.11 <br /> a.nenapatar 1 Canpairy wma u.s.l�r r;t�7'4747 <br /> irperulFrn f`ir�n�rrl erakgN""SRI pFlt7JFCus11DM 8766-0404""1 .' <br /> u.5.EPA l0 NumLer <br /> Y.Tmnappinr 2 Ca'^vanY Name � L'.}apraP.257A43- <br /> L]rNmxf FnlM nnmerrtel Mceia <br /> ecem.a <br /> Sire <br /> U.S.E9AIU NumMT <br /> s.D°�1e°ee FaardY nam.ane p�pg814S7t170 <br /> nf!ra <br /> 11507 ViL lcen Rd PO BM 178 <br /> 13MYYl Ali 72016 <br /> f <br /> Fal 'e Pfwne: <br /> ga, 1 11.U.1.DOT DeFolpaon(�dil Prlp¢r Skil Name,head clue lu Nwnber. rp-�nlelnen 11,T l 1Z U,^ 13 VJesle Codes <br /> NM arwpxking(; gillranryl) No. Type ❑vanblrMW <br /> DCIOl vws -w14 <br /> 1.UN1953 vo-ste F7rammehlellgratd,il ler:*bnB.eCryllcyttNn� <br /> o 3,11 <br /> 2. <br /> Ad <br /> g1e p1 peace»� c? <br /> G <br /> 'Pdr+red NeIDe� ' <br /> Yea 3. <br /> 17 <br /> dl 'rySromtre^' pNc l <br /> pd6,eae belts+' <br /> \ rl <br /> 1e,spatial Handling Insa,Adlre and Additional Ie It DG"11"WeS Cl 1121'_'-1 <br /> G t•,, ecelPt}or Merchandise <br /> '¢turn F 1 9Crrfile01402-0119 C2O7 ERCA1128 �- <br /> p c.o.p, p res r � <br /> ry4 fF re Feet r 15. DENERATOR'SIOFFEROR'S CERTIFICATION:I hereby¢lane That Ne-Merrta of Nre nmsignment are lolly end ari,rralelY described above by Ne pmpar shipping name,and are dassitwth p tim'Yd. <br /> �5 morkedandlatl¢Iedlplara+ded,and arein all respeclsin ld p—nditlontoriianspwtaccanding toapPlimbleinlemaWnalandnabonalgw mm kalvgulatm-It e�al sSlipmelll andlam the Primary Ngo <br /> 0�7 y M- r Exporter Ioatm Mel the wnlenlS nfthis consignmenl contoim to tela terms of the suached EPAAclmowledgmentaf CansenI aY <br /> �5954 1�' 4 dI am a amara quantity 9Bnefdlprl VS true. _ <br /> I certlly that the waste minim¢afion aialemenl identified in 40 GFR 252.27(a)0111 em a forge guanGty generators w(I l pay Year <br /> Generator's'Olfe es Frtnled/ryped Name .. Day Ye21 <br /> 16,hmmahonal shipmanls ❑Import W U.S. from U.S. Purl of-inyVerit: <br /> Osla reeving U.S.. <br /> TLMcapodersignature(tor exports only): <br /> yORe'FCH°n <br /> w 17.7ransporterArSnowledgmenl ofReceipf of Materials Man1h pay Year <br /> Transporter 1 Pdntedliyped Name 1 ! Slgnalure ( _ 1 <br /> M MelOay Year <br /> GTransporter 2 PnnledlTyped Name S'nalur0 <br /> Of <br /> 18 Discrepancy 4aV Yea <br /> I18a.Discrepancy Irldica8on space Elpuan6ly ElTa ❑Residue ❑Penial Re)ec0pn ❑Fu4Fle}eclYoO <br /> Madifesl Ralerence Number. <br /> U.S.EPAID Number <br /> Z 1Ab.ARernals Facility(or GenaratorJ <br /> _J <br /> L) Veal <br /> 1 <br /> Fal Phone. Month Day `fear nth Day <br /> C3 19c.Signature ofAlterrace Fad rly{or Generator) <br /> Z 'S 1N1SIA�COP <br /> 19.Hazardous Waste Report Management Melhod Codes(I a-,codes for hazardous waste treatment,disposal•and recycling systems) <br /> LU <br /> in <br /> 3. 4. <br /> 20,Designated Facility Owner or Operator Certirlca8on of rewipt of hazardous materials covered by the manitesl except as nded in Al 16a <br /> PrmledlFypedName Signature Month Day Peal <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolela. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, EHS Page 32 of 38 <br />