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E. 41h St. Record ID# PR0514018 <br /> 9/2/2020 Program: HW <br /> Photo 34: The following uniform hazardous waste manifest(000199886DAT) observed lacking a signed copy from designated facility. <br /> -,M B,a aPProPdatea � - i + <br /> 9 <br /> Please pint or .rFmm des fled rN use an eMB ll]fildt) LL.I FamtAPPtwed.OMH N0.2e56A0a9 l <br /> UNIFORM HAlAR00I19 I.Generawrlb Nunhe+ 2,Pope 1 d ]F'n't9ar 1 new�Rwre 4.WNM1Rinc n9 Humble 1L <br /> r l WASTE MANIFEST C-APBe7471A!sN 7 It=8263 00 DAT ' <br /> n.rere arra ua�ay r�m�, ,�T`yyl.CA yyr.*n— ea,n.mr.sa0am�cn mrte�sn own m.&v.ea—A <br /> y t3a7rrrt i xMsa7.sar+eaan C#rnterF a anlrraexman i <br /> �F�41 222 Fail Fourth 8e <br /> s Fl1�U063� iiipvr,Gh053Gi."a <br /> 1! cenermory ripe. 2Oki5B9-8137 'r. <br /> ■�■7l 6.T�aneooner 1 GaTpany Name a 5 FSA w NUnper <br /> krgmrlfrr (9avaenxanira!("•'FRI PHONF C1n[N711 0740-0004'••' GPii000110747 <br /> T TmnapMn 2 Company Nemo <br /> US EPAIbN— �S <br /> I [)Ftlwrd Fnitarrmrny!HwnAcer L:M9N�67143a .__ <br /> I 8.beaipnared Fatlllty Named^d Site Adtlresa U5.EPn Io elumd¢r <br /> Ga7rllr ErnlydlrT7orldT.9oMr tic>.ar L LC ViR0�Ct012"7625 tl{3`•r <br /> 1 <br /> Portage. <br /> 0!d N 463!rd <br /> ( �.N 46366 <br /> Fatdll apmna: 27713-8164 F <br /> �IS.DOT Lee V en llaGudng Pmpar SN,ln Name.Hazard CL—PD in Conlainan 11.Tobi iz unk 13.Waab Casae <br /> HM and Petldng G-P la any)) N^. TYPa Qoentty YIIPlaI_ <br /> c 1 Ncin4;fcRA!'lasadaur wattle grand(plq-Iq{I cis Emin4 <br /> CLEAN LFP) <br /> nlem 2 <br /> In <br /> }the <br /> 8cessary{en d <br /> �e er <br /> ��ddshercodes. 4, <br /> f�insli <br /> hwtuenl 1 <br /> 11 <br /> !ma Unils in rid <br /> .tB 14,Spatial Handling Inslruclions andAtltlidonaf IntemnaEien <br /> h-donfbrelch s. ©omn-i 057328 Saba Omer 991809 <br /> �recliry 1)PF0M0# 000176930 DOTFRO# <br /> e, d Wastes and <br /> 120,1al <br /> on of <br /> fPCB waste <br /> In 15. GENEFtATOR'SlOFFEROR'S CERTIFICATION: hereby tleGarB that the mtdenfs of btis wnslgnmentare lolly antl aeLunllely desrnbetl abrnwby the 4ra4er 9hippxtg name,aId are Classified.gacla0ad, <br /> paus: g i F_eporter.Iembi,/Uel U'e aonEenrs of des consignment conform to Die h ms of the axached EPAAcNnlrMgment of Consent. <br /> I Cory mat the wasteminimiaaiion statement ld l dFred in 40 CFR 262-27(a)19 V am atarge quantity genemloYl or(bl(61 ama small%—fi generator) <br /> YdGlaslOBera(s PnnledRyped"Nrp_m7'a-V1 i f .r,,..+ M-th <br /> statement In is " <br /> 6ficadenh <br /> , ,s no ot <br /> r <br /> !gaiyJ Ye;ar'r <br /> 7 <br /> - <br /> 76 Imematioral SM ergs' ❑irni re u.5. ❑Expodfroin OS. Pon of enbylexit: <br /> ante minim,zatio lied iT- <br /> z - <br /> at they haye co-me. and Transporter signature(for eepons Only) r Dele lamdng U 5.: <br /> ficohon also contains the <br /> of oper w 37,TarapnnerpcknaA'Iedgmantor Receipt of Malenals <br /> red and is 1n plop 9I - W Transporter 1 porred7fyped Name Slgnalure • 1410111 gay Year <br /> merit Of the shippers lisp, O <br /> �nlenls of this a :. <br /> el shipping name end 'erd i Transperli Prinfed/typetl Name Signature Month flay Year <br /> prop eCis in pipe C <br /> er 1a <br /> Id are in all resp r <br /> and national go�mm"11 of <br /> cer*that the Co nl" 78.Discrepancy <br /> yrter, mant of Cone - - <br /> ap Aaknowied9 Ifi15 pasty gent 788.Oisrrepancy indicalron Space quantity ❑Type ❑Residue ❑iRejedi0n ❑Full R1:yactl0n <br /> lmentfortranspohad0n. <br /> a f the shipment <br /> offeror G <br /> ent. sy ra Manifest Relerence Number'. <br /> -on behalf GP to theOre 18b.Aitemate Facility(or Generator} O.S.EPA ID Number <br /> e black pndr to signing agent <br /> a <br /> m loyae or <br /> A <br /> fidual <br /> Signs asthe e P Lj <br /> Item 8 LL Facili sPhone, <br /> wired in 15 m Y N <br /> n gnalure Bq W 18c.Signature o(Aflemate Facility(cr Generelor( Month gay Yeat <br /> Z <br /> 0 i8.Hazardous Waste Report Management Method Codes(I,a,codes for hazardous wasle treatment.disposal,and recycling systems( <br /> L <br /> f. 20.Designated Facility Owner or Operalor:Certification of receipt of hazardous materials Covered by the manlfeal except as noted In Ilam 18a <br /> PrinredlTypedleme Signature Month 4ay Year <br /> EPA Farm 8700-22(Rev.3.05)Previous editions are obsolete, GENERATOR'S INITIAL COPY <br /> JASON GAITAN, EHS Page 34 of 38 <br />