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E. 41h St. Record ID# PR0514018 <br /> 9/2/2020 Program: HW <br /> Photo 35: The following uniform hazardous waste manifest (006687315SKS) observed lacking a signed copy from designated facility. <br /> Ste- 9K SHIP* c"26945a30 7039 <br /> Plea Se pont a t19e <br /> UNIFORM NAZARn011e r��vaen 1p x,myyt p�p� Fan pmvM OM8 No.2050-0079 ' <br /> WASTE MANIFEST CAI3582471856 "—J' a "'��-9bY-1 f6@ 4 xaniraat n.ema x ,r <br /> m rem 1 5 5K5 <br /> '�ti SC e,elul xanennd MaiMB pyaies, <br /> Gunt rrt R T1Mrerran Const Div """"s"`"^0'°61dd'^ °'a^^'•��'^z e*+As+� <br /> RIPON 4th 9t <br /> CR 95366-2761 ]as <br /> c—,-Pr4,,, 209-599-6t31 <br /> a SYSTEMS INC trseP.lo N.m�. �I T <br /> � TYlRO@00B 12fa5 - <br /> r rmewvnerzeomParry Hemp <br /> VS.EPa10 M' Im S <br /> e oe„y„ted F—ty wme gee sew aadra„ 7 <br /> SAFETY--KLF=EN OF CON-IFpRNIR U EPA LD N.— � <br /> f 6980 SMITH AVE. <br /> r 510-795-4400 NFWRRK , CR 94560 <br /> route sFhane: CAI19$0687418 <br /> i 9a 96.V.9 OOT Oasrnpfgn pncfuGng l'mper slappiq Name.HazaN c�ss.In Nuns», 19.Con4xners 1t.row 12.0 t --. <br /> I NM ane PaWuiy Gmup til anvil No TYF Criamily WI Nal 13.Waete CcOes <br /> ' NONE NON—RCRR 14AZORDOUS WA,,',TE TT 2i*t <br /> o LI00fuS, (WII OIL], N/A G <br /> F 1 <br /> 3 <br /> 4 <br /> 14.Sp­&11 HaMlini;III M ter ne and Additional lntmn,aeon T5UrEVG 76429622 W12272 CSG: <br /> ides, 24H EMER(3ENCY#800-466-1760—CH/5K/TFI—Contract retained b <br /> y generator confers aggenvy authori y v <br /> yluenl On initial trans Orter tO add or substitute additional trans orters on enerator's behalf_ <br /> 15. CENERATOR'SfOFFEROR'S CERTIFICATION:Inereby tletlare that the wnlents orchis wnsignmenl are NLLy and acrurafely descnbetl shove by the proper shipping name,ab are tlassin9d,PackaBad, <br /> • rt1a/ned and Ieheledlplacardetl,and are in all respects in properwMilian fd lansport according to applfable inlematianal end national governmental regulations.if expoM1shipmetN and I em dre Primary Year <br /> which Espoder,l mII thatmewnienteof this consignment wnrorm to the teems of it—Itwhed EPAAckr*Medgment of ConsenL <br /> 1 wrtihj mal the waste minimlzalian slalemenI itlentihetl in 11 CFR 111,11(al[if I am a large....l,y generator)or Ib)III am asmall...i thy gelraamr)15 true. <br /> tes artd GeneatafslO&MI's PrintedTTyped Name Signature ALnnlh Oay YteaGr <br /> walla N�"", <br /> 811 16.Inierna0onal Shtpmon6 <br /> Dry - ❑Impod tp U.S. ❑r,t 't hon d.5. port of entryi-L Vear <br /> ? Transpoder signature(foreapons-1y) Cale leavi�lg U.S.. <br /> 77.TamporferAcIdI Medgment of Receipt al Matedals Year <br /> Int. In TrapspolTer I Pnnted/Typed Name Sigpetuts tApnth bay Year <br /> ar Q D . Tjq;.kL IICA I ! <br /> ? TranSpnrier2 'ntedlTyped Name Ir Month Day Year <br /> ad <br /> 15 the , 1 1 ,}ecnan <br /> ♦ ie.Discrepancy r. <br /> IIIl11I tea Discrepancy lndicalion Space Quantity ❑Type ❑Residua ❑PadiaV Reiectton ❑Fun Relectlon <br /> and <br /> Iyer Man9esi Rel anr4 Numhar: <br /> 1 �:f Ieb,Fdlemale Facility(ar Generator) k U.S EPA O Namber <br /> fs of av Vew <br /> grit." U <br /> arty Facility's Phare; <br /> w 18c.Signawre olAlamale Palalily(or Generator} Month Day Ye2t <br /> H <br /> rn 79.Hazardous Wasia Repod Management Method Codes(I a�.codes for hazardous waste treatment,disposal,and recyGmg systems) <br /> 3anl 0 1 2, <br /> ay 'sear <br /> ay <br /> -- -�- 2tt.Designaled FaG1ity Owner or OperatorCerh icalioe of Iacelpt of hazardous matpnals covered by the manifest except as neled in 11 158 <br /> PrinledlTyped Name Signalnre Month 4ay Veal AL COPY <br /> "W <br /> EP;FqI $]QQ:721R� .7 }jLP�r�vious editions are obsolete. GENERWOR'S MMAt COPY <br /> )H489c'l2 7'97 <br /> JASON GAITAN, EHS Page 35 of 38 <br />