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E. 41h St. Record ID# PR0514018
<br /> 9/2/2020 Program: HW
<br /> Photo 33: The following uniform hazardous waste manifest(000247550DAT) observed lacking a signed copy from designated facility.
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<br /> awe Ir ibeklwJ 3-r wa v WA5TE MANIFEST
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<br /> ids anrp rnerE n-uN�RS OFA C3mtmi 8 7lmmermen
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<br /> sonryy undo lilpal CA 95366 Ripon,GA96366
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<br /> T a.L7gNc V-GYblc Yard._ 6.Transpmler 1 Company Name U.S.EPA1n Nmnher J
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<br /> k aaY redpral entl slate wade LadenW dg eadl uS9ae aa9em identified m e.Oeslgnal@d FamiH Name ant$iI@ Addmaa U.S.EPA 40 Number
<br /> ata caste my s Mat era not radurraanl wilfl federal Wdas
<br /> I m rho ladardl waste codes whMt are moat
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<br /> +apreaenmtive ollhe pmperbaa of he INRgO0i27621
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<br /> trots maYanrerany sPsa$I handtrn AGO" 219-713-6i84 1].waste cocas '
<br /> 'ermanagameat oraaprrrng ollhe melena am sPeRlic lnPormatidn nanessa fp Fear sPhona:
<br /> s' �p,v^esses,sash as wase launder the generaror'a aroarer 7 sa. 93-,U.9.DOT D96ogbml Qntludng Pmpar$hippirg Hanle,Hazam Clau,Ip Hamper, 10 Can,a'lnen 11,TdW ,12,vl Nor' 13,Waste Cacho
<br /> se t7urde numbers Generdlora efso proh'fe num6en;.rm+rMMerraMes, end,e ,Grant,(if any)) no Tye p1anty .
<br /> �rnrytnna6'dn about then stir '^aY pso
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<br /> yr specific grewry of wades fdentltied wi K t
<br /> M vorume amts In � CLEAN UP)
<br /> raybe used in coraco bmlkd types of federally required lnramyyon for .
<br /> eerCCs,01-51 vfded nn flie manjfesL including anyalremsle laclhry Z
<br /> 'he mane of rm g numberofthe on whsh Ud
<br /> E rl>-shipped underasecon 9ulal manrlest for mleeted wastes arta
<br /> f PCB out-of-a dmarnlesl;end the specsfrca[ion of PCB w18"
<br /> s^deo dales req uimdundera0CFR78L2R7 GeneraWas
<br /> Le required to ente'Info rmatin in This space m mea n
<br /> 1 stare regulatory
<br /> to
<br /> azrs C6rliflCaaons
<br /> I coed,argri,and date the waste minimi,
<br /> covicali. sfalemeni,i-
<br /> jntinlration cer6fir h n stalemenr,those a_
<br /> acute erregulatfon from the drrry to make as wase ON who hao-en rN .,
<br /> "an 300,2(6)OfRCRA are also certifying that Iheyhave complied
<br /> alion reguirements. The Generator's re ed
<br /> elm
<br /> I l shipment has been la.Special Handling Inswcdons and Additional roromabon 670461 50 119728
<br /> P.).?Prepared and is g, wnkrrss the
<br /> (Ile slup'fh cerG(+caaon.m Proper
<br /> as fp1101f's:Yhera6 d ) e mr+rentofthe shipper's 1[10001 73-830
<br /> iaccyra Y. adore that lhecontenLa of this dsiaeilaS4. m'^=lfied,packaged,
<br /> left'descyf6ed above by the praRershgcpfng name,and
<br /> 'narked andlabeled/placarded,an 'rnlrel-i eefalrl°r1 6t'geneTBfOC CO/lfeTs agency altlltOrlty�f>7nirill hl➢IaprrcLai l°add or 4M�1t�1/e arL]illerltaYinlrtL�anrta[R'+n a e.ani ora UasaAted.4ed. d 1 am me Primary
<br /> ndtng to applicable inlemeG'onaaand nein ah'respecfs jn Amper 15. OENERATORWOFFEROR'S CERTIFICATION: hereby declare that Ne contents of cols mnsgnment cre lulls end acwratel dess+ibed atxlVeb Ilia proper s ipprng
<br /> rent and fora fne Anme tio.a I pt'6onaf govemmenlal marked and la6eledrplacarded,end are mall respects in proper.,dit.n rot transport according b appGcadle lntemationalaM national govemmanral regulations,if export shipment and I am Sha Primas
<br /> Me N!nacos of the afrached EPAA ro(y that the contents of Exporter,l e6rtlfy Thal the oontenls of this consignment conform Iv the terata of the attached EPAAckilowledgmenl of CansenL rotor is Imo. ,Ae^m pay x—
<br /> ON
<br /> o! antlly generator)or(6}(111 am aamaA quangly gena }' MOP>h pay_ Year !
<br /> 98nerafor prepares the shi Consent' I certify that ihawasta minimization stalemem Idendfred In a0 CFR 262.27{a){d I am a lave qu
<br /> Signature r
<br /> IftiBralion sfaremWas fhe 0Nerorpaf fhIs at n,this parfy GeneralotslOffau t P-ro- Yped N-cro
<br /> l may,oMPrinl Me i'mro'a," rf�1 V� ! I ti l V. ! I ! - --
<br /> llementin658 behalloP jn she signature F,pad from U5, Pgrtgl entrylsxiL
<br /> 5lgnaftire black pfior fp signing rhe 16.lnterrlalignal Shipments Impon O u s pate IeavVng U.S: �mtth pay Year
<br /> indieale that the uidividual signsas the employee aragenl ? Traneportersignalure(for exports only) g
<br /> :
<br /> Monro 4ay Year
<br /> Ycept the handw6Re1g nature a 17.TransponerAcWwwletlgncenl of ReceiRt of Mateda€s SignaWre Ants gay Year
<br /> g 2gaired in lfem PSmay r Transporter 1 Printeill Nl ! l
<br /> a Signature
<br /> Z Transporler2 Printedfiyped Name I�
<br /> �.�}f ur1 Reledwn
<br /> 18.Discrepancy ❑Full Relecuan
<br /> 18a,Discrepancy lndicalion Space Quantity Type
<br /> ❑Pesldua ❑Partial Reledien
<br /> Man11051 Reference Number:
<br /> U.S.EPA 19 HUmber
<br /> F 18b.Alternate Family(01 Generator)
<br /> Ink h 1]ay Year
<br /> U
<br /> w Facility's Phone: Mgn4h pay Year
<br /> U- 18c.Signature of Allem-W Fl I It(or Generalori
<br /> a
<br /> z
<br /> 19.Hazardous Waste Report Management Method Godes[i.e.,codes for hazardous treatment,disp3sal,and IecycAng systems) 4
<br /> W 4 2.
<br /> In Day Year
<br /> iteslexcept as ndin Item 18a
<br /> 20.Designated Facility Owner Or OPM137 C"r`atien of fecelpt of hazardous ma-l—covered 4t'the maned A1oiilh Day Year
<br /> Signasure
<br /> prinledlTyped Name INITIAL COPY
<br /> SERASOR'S 1NiT1AL COP`(
<br /> AItil editions are obsolete,
<br /> JASON GAITAN, EHS Page 33 of 38
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