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E. 41h St. Record ID# PR0514018 <br /> 9/2/2020 Program: HW <br /> Photo 36: The following uniform hazardous waste manifest(006545230SKS) observed lacking a signed copy from designated facility. <br /> - <br /> � � ,r, 6 s��� FomIAPPIPVE-0-OIv19 By <br /> 20/50-0039 <br /> ., �m or IFnlm eeslaaaa ra ase on ettte llz�ies11 .3 SKS <br /> aM H=US I�'r W 10 NUMer 2 Pj 1 al 3.Fi'rPF ate'^Ham' rt <br /> CAp9$2k711I <br /> I STE MANIFEST , <br /> Q Y' ��. }� IMS Name altl MdJ�9 Me�eza CYnenMh Sire A4Neu 4A NRe�man,raAie'.9 a6'eesal <br /> j�A 1:9r`S � kJ,iGPf'aliT CGn�'G �iV <br /> RIPON 4th SL <br /> CA 4536d-2761 <br /> � d � L74,�,� .. a ir! k_p -'ralw's PnolreZo9-599rb 131 s_sPAro NumoOl <br /> w ll. <br /> j'forw9w srsrEns INC <br /> 45 �� �� �(lt-1, � �. - � ienwe0a+!compe�rrvome V.S.EPnw Numbev <br /> td U.S EPAI➢NumEm <br /> m [7A R l pawg„Iee FadlM deme anesiu Ammss SAFETY-KLECN 5Y67Er.=. I+I- <br /> STREET <br /> on <br /> t4 3, _ sACRAnENT0 <br /> ry <br /> � b - 91d .3tg6-4`Y13 <br /> reef:'s phone: <br /> o <br /> 9e.U.S.00T0esalptlon(IMIItlilla Pmper ehiyplrg Nems,rKzeal Mass'IU NIVri-.. NoCanle�nars Ty11'WI t2 <br /> So Nr3.WasM CoOes <br /> ane P" Ia Gmvp('repY71 N. pe aallen t <br /> vnrra. .. <br /> 3 n <br /> 1 HM <br /> ❑Q hOH-Ii HAZARCQUE IJoa57 E, Li0Il1D <br /> (7p tAGi1JEUt15 FA T5 WASHER SOLUT10Ni <br /> r"1 <br /> $ z <br /> 3_ is <br /> ed <br /> IS the �B <br /> Ise <br /> 4. <br /> aftd <br /> Ier 14.Special Nentllin9lnshucti0nsand AddifionallnfonnaGaO TSD:SCA 7-1 <br /> 5 of <br /> arty 24 .R EMERGENCY V 804-468-}.7bOCSAFmCTT-{::' <br /> A6TR AS AGENT-FDR" P`' 6P4 T'C! RE7A3N 1..:: a oce r ne <br /> 15- GENNERATIJand abe3�dlP�aROR'S,CERTIFICATION: <br /> [herkndPrdacbmrldetion fot qla relre spodrtont$-f laeeoN�9 maPPlica6le��nte elionaka anaRoaa gavammenWl erequVatians1lS erpcd singment anE lam rhePP MN <br /> ]Bnt Expnder,I carfiry Nat the contents of this canslgnmenl aonfonn to the temis dlha attached EPAllcknow4edg of pCdnIWit <br /> kam a5lnaA quanti ratar}ts naa. <br /> faerSTY rhaE the waste minlmiza600 sratemenl ldena,ed In M3 CFR 26227Sal tort amalarge quantlty�9n5 <br /> 5 (ll Ty Monty pay Yeal <br /> ay Gen srQff'raft Prinled/fYp�d Name •r"L I-I r•1 <br /> 1.nlemac alshipmenls �Impon mtJ.s.' ❑Expnd tram .s. Padatennylexit. <br /> 4ate leaving U 5 <br /> -- - -I � YrartsportersigneWra lfor eryoris only}: <br /> iX 17.TransporlerAdmawlad9lof0af fAalelials 1.1one< Day, <br /> I-,�YranspoJ(t1er PrinledffYP Name <br /> d �y-1 I .. Slgndlvra 6Aon111 pay (teal <br /> 4 Transpoher2 'nte ped Narnei <br /> T18-Discrepancy L1FuH Rajeci+an <br /> ❑Residue ❑Pariia!Rayec4Von <br /> I 16a.Discrepancy Indication Space �Quantity �Type <br /> IJ Mankfesl Relerana,Numbec <br /> C.S.EPA VO Numhar <br /> 18b.Alternate Facility(of Goneralor) <br /> J <br /> V <br /> Month gay Year <br /> < Factlity's Phone: <br /> i8c.Signature of Nlernale Fadlily(or GeneMIDI <br /> 4 <br /> ZV,and f clm 5 5lBm5 <br /> 0 14.Hazardous Wasle Report Management Method Coda,(i.e.,cedes for hazardous waste beatmem,dispose eoY 8 Y 4 <br /> LU 12 <br /> 20 Designated Facii owner or Operator:COdifiCallnn of recalpt o}hazardous rnateriais wvered by the manilest excepl as road in Item i8a pay 'foal <br /> Signalule <br /> Printedltyped Name <br /> GENERATOR'S INITIAL COPY <br /> EPA F4118700 2��f�e Previous editions are obsolete. <br /> JASON GAITAN, EHS Page 36 of 38 <br />